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a <br /> -�- ` SAN] 0Q U I N Environmental Health Department <br /> r . <br /> COUNTY <br /> Greatness grows flea•. <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: p City: <br /> Well Location APN: C2.)3 r'qL7 <br /> Well Latitude: �, �p7 Well Longitude: 0-100 33 0 <br /> Flood Plain Designation: Well Elevation:11-74 Z <br /> Applicant Name: /<e"A &ee S Applicant itle: Oj 14f �- <br /> Applicant Address 2-0240- -3 City: <br /> Applicant Phone: 3 ;?-7.77 Applt ant email: <br /> Property Owner Name: /J'f; e T e,,7 en <br /> Property Owner Address: City: <br /> Property Owner Phone: 9 /Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 1 �'� Acres to be Served by Well: <br /> Use of Well; <br /> EI Domestic Irrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): 2W <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated 96mulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> l' <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 ElMunicipal Public Water Supply ElIndustrial ElStock <br /> ❑ Other: <br /> Total Depth(ft): 350 To: From: <br /> Casing Diameter(in): '^ D-Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rte(gpm): 3 /� To: From: <br /> Annual Extraction Volum (acre-feet: C-,-r-Estimated ❑ Measured <br /> Specific Capa ty(gal/min/ft): 737,9,,j <br /> Other Pumping ests 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 />