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3 A N ! M I N Environmental Health apartment <br /> ---C ®U N T Y---- 0 <br /> - <br /> Gieatness gro",F herw. <br /> New Well Information �P, <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 /> �2 �5 1\ <br /> WELL LOCATION AN OWNER INFORMATION <br /> Well Location Address: j City: <br /> Well Location APN: �- 0'16ARP <br /> Well Latitude:3Y,pYc�,641 Well Longit.ude:l I a,U. 901ZI <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: �;�; �� Applicant Title: " f e r- <br /> Applicant Address: p040X 6,VW6ocf"eCity: J; <br /> Applicant Phone: D g-_33 _ S- Applicant email: <br /> Property Owner Name:(— en Dtt <br /> Property Owner Address: or r rb City: 64 L t- 'G 7 <br /> Property Owner Phone: 8 j7 _ Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I L&W Acres to be Served by Well: 43Y0 24 a <br /> Use of Well: ❑ Domestic 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): 2,6Av f Estimated Pumping Rate(gal/min): 3� <br /> Anticipated Pumping Schedule(gal/day): I rL'A I vaEstimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): l <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: r <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: <br /> ❑ Domestic t31rrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): Se90 To: From: <br /> Casing Diameter(in): 9,,fx ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): pD A (Ank,)em-:M To: From: <br /> Annual Extraction Volume(acre-feet: i0lo EX Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): yoo ,k, o „ <br /> Other Pumping Tests Performed: ����,,� Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />