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SANsJOAQUIN Environmental Health Department <br /> F'_: COUNTY <br /> r, ,-' Greatness gro:v, 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 <br /> known. The Environmental Health Department must collect this information before a new well <br /> permit is issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION" <br /> Well Location Address: 1 1 O City: a <br /> Well Location APN: 063 -Zl O - <br /> Well Latitude: 38*y y �► Well Longitude: j 2/o _ <br /> Flood Plain Designation: kj IA <br /> Well Elevation: 0' <br /> Applicant Name: 141,*^ Applicant Title: ry-�,KA <br /> Applicant Address: � �,y�Q f2 City: C <br /> Applicant Phone: _ -;r_ Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED,WELL INFORMATION <br /> Well Total Depth(ft):1 I LICOO Acres to be Served by Well: <br /> Use of Well: <br /> ❑ Domestic XIrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): ( QO <br /> Proposed Well Capacity(gal/ft): /ODO Estimated Pumping Rate(gal/min): 70 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 3 /Met lite <br /> Esti ated Cumulative Extraction Volume before January 1,2020(acre-feet): ,�v <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: <br /> 'Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): 300 To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): j To: From: <br /> Annual Extraction Volume(acre-feet: ted ❑ 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 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />