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.,^pnUf - <br /> z'°"'"�:c°�i SAN)IOAHIN Environmental Health Department <br /> COUNTY <br /> < r 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: G' /V City:Well Location APN: DS ///0(o S <br /> Well Latitude: 3 Well Longitude: H„Z1: a <br /> Flood Plain Designation: Well Elevation: f <br /> Applicant Name: .ke;p_ Applicant Title: ,,/f« <br /> Applicant Address: PO 17 City: "/ood �( <br /> Applicant Phone:-33 y Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: s�,� City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): oc, Acres to be Served by Well:1 15 },} <br /> Use of Well: ❑ Domestic [Mr-rigation ❑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_00 Estimated Pumping Rate(gal/min): g(X.-? <br /> Anticipated Pumping Schedule(gal/day): /6 0 Estimated Annual Extraction Volume(acre-feet): G 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 /> Use of W II: <br /> El Domestic El Irrigation El Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial El Stock <br /> Other: <br /> Total Depth(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: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: _Test Result: <br /> 1868 E. Hazelton Avenue ) Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />