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p <br /> C' <br /> New Well Information <br /> Pursuant to California. Water Code, Section 13808, all new wells that do not meet the exemption <br /> criteria must submit the following required information, to the extent that can be reasonably known. <br /> The Environmental Health Department must collect this information before a new well permit is <br /> issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: rj.5-11 -r--, t2�AT I City:1 L'Wpt-A) <br /> Well Location r <br /> Well Longitude] &6 57 <br /> _Tlood Plain Designation: Well Elevation] 16,7 <br /> Applicant Name: e J-.14% 61-,75 Applicant Title: <br /> Applicant Address: 60 rV City: <br /> Applicant Phone: 09- — 7 Applicant email: <br /> Property Owner Narne: L,0 Uv Ck S L <br /> Property Owner Address: ri P= City:1 <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 1 5773 0 Acres to be Served by Well: <br /> Use of Well: Ej Domestic krigation El Small Public Water Supply El Municipal Public Water Supply 0 Industrih El Stock <br /> 0 Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): i e- Estimated Pumping Rate(gal/min): 'I <br /> Anticipated Pumping Schedule(gal/day): �_�:tp,17 Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1, 2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: 0 Domestic 0 Irrigation El Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br /> El Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): 0 Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gP111): 14n klipj I To: From: <br /> Annual Extraction Volume(acre-feet: 1626 � Estimated 0 Measured <br /> Specific Capacity(gal/min/ft):W"'.-1, <br /> Other Pumping Tests Performed] pJr Test Result] <br /> 1868 E. idazellon Avenue I Stockton, California 95205 1 T 209 463-3420 1 1!.. 209 464-0138 <br />