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i <br /> SAN od 0AQ U IN Environmental Health Department <br /> iVnh � COUNTY <br /> Greatness groo s 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 011 1 I S . I n ��a�� R C�� <br /> Well Location APN: j _ {p G-O <br /> Well Latitude: 3 2 Well Longitude: Z 45 32.qW <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: oy-� y, -�4cjzgt Applicant Title: Crt&j-^,o <br /> Applicant Address: 1 12:1 ,I 11 w <br /> KN� 2 City: Ut <br /> Applicant Phone: 2ao, Q Q _ 988 q Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDYVELL INFORMATION <br /> Well Total Depth(ft): I Acres to be Served by Well: 2,'33 <br /> Use of Well: <br /> ❑ Domestic )(Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): (opo 4- <br /> Proposed Well Capacity(gal/ft): /QOO Estimated Pumping Rate(gal/min): /000 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): _?a er-e i <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): Al <br /> EXISTING WELLSINFORMATION <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: ❑ Domestic XIrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ 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): q00 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 vwvw.sjcehd.com <br />