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°P"° JOAQUIN Environmental Health Department <br /> �" ` COUNTY-- - <br /> `c9CfP `P! Greatness 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: U . /3,,-,4 City: V iL ar <br /> Well Location APN: O S 1/1(2(0 5- <br /> Well <br /> Well Latitude: 3 3 Well Longitude: I J_1, a oy Sp <br /> Flood Plain Designation: Well Elevation: f 01�fi <br /> Applicant Name: C2%ss Applicant Title: 0,,Iffe <br /> Applicant Address: PO 17f City: <br /> Applicant Phone:33 _ y 7,Z,S Applicant email: <br /> Property Owner Name: 0,,LK /n Gk <br /> Property Owner Address: Sties e_ F City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): X10 Acres to be Served by Well: (� 5 <br /> Use of Well: ❑ Domestic �rigation El Small Public Water Supply ❑ Municipal Public Water Supply El Industrial El Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 200 Estimated Pumping Rate(gal/min): aLO�-2 <br /> Anticipated Pumping Schedule(gal/day): /6 0 Estimated Annual Extraction Volume(acre-feet): ( 7 U� <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 /> ❑ Domestic ElIrrigation ElSmall Public Water Supply ElMunicipal Public Water Supply ❑ Industrial ElStock <br /> Use�ol� <br /> Other: <br /> Total Depttl{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: ❑ Esti ❑ Measured <br /> Specific Capacity(gal/min/ft): - <br /> Other Pumping Tests Performed: est 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 />