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r"AN J OAQ U I N Environmental Health Department <br /> C---"',J N T'r <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: aa-14,5 104 I City:. L"" <br /> Well Location APN: 061— QtA 0 O <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Applicant Titte: <br /> WI)..P. .....-- <br /> Applicant Address: Po ol. `l 3� City; <br /> Applicant Phone: 2 _ $ 5/� Jr Applicant email: ICtrri& n ''toes+Ir1G, r>7 <br /> Property Owner Name:3� �iUp�nY t Sb to -C OQk►r ki% + e✓ k% tl l.l_(— <br /> Property Owner Address: P p /� 3 City: L <br /> I Property Owner Phone: 7 _ 8s _ S Property Owner email: kr m a <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):j Acres to be Served by Well: Aq Q t c_ <br /> Use of Well: ❑Domestic rrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> _ ❑_Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): rj Q Estimated Pumping Rate(gallmin):l 12 Q 0 <br /> Anticipated Pumping Schedule(gal/day): � n $00 Estimated Annual Extraction Volume(acre-feet): <br /> 0 <br /> —�---_._ <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): Q <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): j 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 />