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wn <br /> z S A N J O A Q U I N Environmental Health Department <br /> COUNTY <br /> Greotness grows here. <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: 27-5 E 4h 6 City: h e <br /> Well Location APN: <br /> Well Latitude: 3 OY33 9 Well Longitude: <br /> Flood Plain Designation: I Well Elevation: <br /> Applicant Name: i�SS Applicant Title: P1,11 ei <br /> Applicant Address: 0 6 V City: wco j",J, <br /> Applicant Phone: 33 q y 2� Applicant email: <br /> Property Owner Name: 00 boa,, 06,10 u L <br /> Property Owner Address: otygo ,//- P city: aL f <br /> Property Owner Phone: 35"a. Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Z Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): GpIYI Estimated Pumping Rate(gal/min): 6Z2 <br /> Anticipated Pumping Schedule(gal/day): 19O&v �4,(j Estimated Annual Extraction Volume(acre-feet): 6 <br /> Estimated umulative Extraction Volume before January 1,2020(acre-feet): 31,1 <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: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />