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S A S <br /> *r PpUIH <br /> SAN . JQ A Q U I N Environmental Health Department <br /> COUNTY <br /> cgL, 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: tQ ,(1^ ve City: vo o� <br /> Well Location APN: pO> <br /> Well Latitude: S y s Well Longitude:� <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: o Tec �� Applicant Title: <br /> Applicant Address: J�,,p Ls City: fog Gn <br /> Applicant Phone: 9 _ F8 7 1 Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: j w Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 2 sp Acres to be Served by Well: -2 -2— <br /> Use of Well: ❑ Domestic C9.Irrtgation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): /. J Estimated Pumping Rate(gal/min): /3 v <br /> Anticipated Pumping Schedule(gal/day): 3 S o Estimated Annual Extraction Volume(acre-feet): v� <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 1 <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 R ttrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): p' To: la From: /s <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: giEstimated ❑ 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 />