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SAN J OAQ U I N Environmental Health Department <br /> COUNTY <br /> c�Foaa`J 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: j I %3 8 Sum 114 City: uc {ems <br /> Well Location APN: 10'3- 17G-Well Latitude: 37 59 2 f Z-z. ' Well Longitude: <br /> Flood Plain Designation: P A Well Elevation: <br /> Applicant Name: 01 ul-c f` Applicant Title: <br /> Applicant Address: ( (ej3$ wh R-A City: +0 L+�7�� <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I Acres to be Served by Well: /Q, 0 <br /> Use of Well: ❑ Domestic XIrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 24Z 6 P V^ Estimated Pumping Rate(gal/min): /b0 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): /-e rS-M,,A 1,rrA.A4_ <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): O <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 <br /> rom:Annual Extraction Volume(acre-feet: /rSS41,42 4ere 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 />