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SAN dOA Q U IN Environmental Health Department <br /> I' COUNTY <br /> Vz: ° Greot,ness 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 <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 AID OWNER,INFORMATION <br /> Well Location Address: 1 2 4{Nry R d. City: <br /> Well Location APN: a_ <br /> Well Latitude: o ' .31 Mt�A Well Longitude: fj \9 Q,?)Gj11 <br /> Flood Plain Designation: Well Elevation:1 144' <br /> Applicant Name: F Ie i tb-t-F h q$ V Applicant Title: Uw r t <br /> Applicant Address: CJ 4t,e R—J, City: IZ-15 e at I a V.- <br /> Applicant <br /> Applicant Phone: 380. 2 Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: �, City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDNELL INFORMATION <br /> Well Total Depth(ft): , Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Vrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): A <br /> Proposed Well Capacity(gal/ft): 3SO Estimated Pumping Rate(gal/min): 2.0D P ) <br /> Anticipated umping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 2 rr-* 1+�t <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 Well: <br /> Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): 61/ ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): S To: From: <br /> Annual Extraction Volume(acre-feet: L..ets ^ L«• Estimated ❑ 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 />