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oPa c <br /> i611) <br /> SA N sJ QAQ U I N Environmental Health Department <br /> `W COUNTY <br /> `�c'tc�Fa�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: Sj„ �A t City: P <br /> Well Location APN: GO-7 -,0 5'q_.tr Q- a p6 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Z' ' S rd Applicant Title: <br /> Applicant Address: City: a <br /> Applicant Phone: Sao-9 �'3' ©Z-S Applicant email: L �, <br /> Property Owner Name: (: 7aM i//p /,Q .`n-f-,AlI <br /> Property Owner Address: fb OX O City:�QGa�,y d <br /> Property Owner Phone: -Zrj - Q Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 6o(y Acres to be Served by Well: <br /> Use of Well: ❑ Domestic"19 Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): lflllq <br /> Proposed Well Capacity(gal/ft): C' Estimated Pumping Rate(gal/min): Q G� <br /> Anticipated umping Schedule(gal/day): /L//14 I Estimated Annual Extraction Volume(acre-feet): ti <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 "Iva e Q <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑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): 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 www.sjcehd.com <br />