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S A N'J O A Q U I N Environmental Health Department <br /> ---COU NTY <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: 106 0,3 4 . fett6y^ City: <br /> Well Location APN: S- S 3 <br /> Well Latitude: c Well Longitude: —12-1 - <br /> Flood Plain Designation: N Well Elevation: <br /> Applicant Name: �'jer^ri 14-04,6^ Applicant Title: VVs�t <br /> Applicant Address: t4$Zp C-j A Citya.1 <br /> Applicant Phone: tj.2 —'&Cp&q Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDJNELL INFORMATION <br /> Well Total Depth(ft): I L160 Acres to be Served by Well-F 6c, <br /> Use of Well: ❑Domestic 39 Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other. <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gallft): r✓` Estimated Pumping Rate(gal/min): SCry <br /> Anticipated Pumping Schedule(gal/day): 4,,% ,� est �ated Annual Extraction Volume(acre-feet): J%K S -A 2 wt N <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): Al <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): 11. 1 ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 16epo To: From: <br /> Annual Extraction Volume(acre-feet: /est 44,VL I mated ❑ Measu <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.corn <br />