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} SAN J U A Q U I N Frivironmental Health [liepafr h lent <br /> CC)Ul.l?'y <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: p5�3�6q \N. G ron+ u Road City: -TY616 <br /> Well Location APN: p . 161 <br /> Well Latitude: 3�.`I 5 8 5 22 Well Longitude: — ►21. 5 O 4-3�3`1 <br /> Flood Plain Designation: -Lpn(v Well Elevation: <br /> Applicant Name: tit r I G kI,5vJ Dr,*Iiinq Applicant Title: <br /> Applicant Address: 1555 N• MCCGtI I mlirlwb City: 561n <br /> Applicant Phone: 1551. 352. -1'7.28 Applicant email: CI6A ar1(5Sty iGkta <br /> wcltdntlin .GOrn <br /> Property Owner Name: S G�rA b I�" � Q 1+ �'f- � WA l <br /> Property Owner Address: 5(pp 1q. Ay- eA j r, City: er�G <br /> Property Owner Phone: 5 3o • 3D • D C1,9 S Property Owner email:gtuja12o-L t? matt,COM <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I Ll y 0 Acres to be Served by Well: al q .3 Gt^C S <br /> Use of Well: ❑ Domestic Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: P& <br /> Depth of Corcoran Clay(ft): un DW r1 <br /> Proposed Well Capacity(gal/ft): Oxy- 1 Estimated Pumping Rate(gal/min): U V41 <br /> Anticipated Pumping Schedule(gaUday): n L„(n Estimated Annual Extraction Volume(acre-feet): uh ayy v) <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): Unk,no W n <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 'd <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-f9 ❑ Estimated ❑ Measured <br /> Specific Capacity min/ft): <br /> Other Pumping Te6s 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 />