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S A N -.,J Q A U IN Environmental Health Department <br /> —COUNTY- <br /> 6 re o t n c s! <br /> OUNTY6reot'r„s:; q rows li. rc'. <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: I City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: pplicant Title: <br /> Applicant Address: City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMA <br /> Well Total DepthX. I Acres to be Served by Well: <br /> Use of Well: ❑ Domest' ❑ Irrigation EISmall Public Water Supply ElMunicipal Public Water Supply b Industrial ❑Stock <br /> ❑0 r: <br /> epth of Corcoran Clay(ft): <br /> roposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): <br /> A K cipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> r <br /> Total Number of Existing Wells on Property: �a <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> 0A <br /> 3 Use of Well: ❑ Domestic 0'Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Total Depth(ft): 390 To: From: <br /> Casing Diameter(in): ,',,, ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): az90 wi k'na_rl To: From: <br /> Annual Extraction Volume(acre-feet: 106, 2 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft):1 ui, <br /> Other Pumping Tests Performed: M,i1 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 />