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SAN J O A Q U I N Environmental Health Department <br /> " Lunt ---COUNTY---- - <br /> Q,' 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: ) y a) j)._ N_� ,� y,: , City: <br /> Well Location APN: a j b o - - <br /> Well Latitude: Well Longitude: • Z 6 v <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: r Applicant Title: " r v,' <br /> Applicant Address: City:j <br /> Applicant Phone: ::;I-Q Applicant email: F K )CA C ✓� <br /> Property Owner Name: ,, -, �, s r� <br /> Property Owner Address: City: <br /> Property Owner Phone: q a C Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I I T O Acres to be Served by Well: <br /> Use of Well: ❑ Domestic [klrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft):_2A'! Estimated Pumping Rate(gal/min): 3 O© <br /> Anticipated Pumping Schedule(gal/day): 2en04 Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cu ulative 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: ❑ 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 />