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SAN J OAQ U I N Environmental Health Department <br /> COUNTY... ..._ <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: Z S;__! 1 City: <br /> Well Location APN: �v 3 <br /> Well Latitude: OJ72/0 Well Longitude: •-1,-Lo, 7 <br /> Flood Plain Designation: Well Elevation: 1 c.7 7f <br /> Applicant Name: Pj,. , 61055 Applicant Title: <br /> Applicant Address; PO /_ 0 711 17 r_ City: Gt/4 <br /> Applicant Phone: o9_ -7It Applicant email; <br /> Property Owner Name: LP 640 LVW Ck 1 L(,-C- <br /> - <br /> Property Owner Address: ke- p City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft):1 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic rigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industri I ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): )L <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet):?/,y <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): �7_062 To: From: <br /> Casing Diameter(in): ,^ ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 14k114V_n To: From: <br /> Annual Extraction Volume(acre-feet: 169e- S� Estimated ❑ Measured <br /> Specific Capacity(gal/minlft): k,,d._„ <br /> Other Pumping Tests Performed: pi, 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 />