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SAN 1 OAQ U I N Environmental Health Department <br /> �C'J CITY <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: 8000 East Kettleman Lane City:1 Lodi <br /> Well Location APN: 061-133-38 <br /> Well Latitude: 380 6'53.73"N Well Longitude: 121013'1.58"W <br /> Flood Plain Designation: Well Elevation: 69' <br /> Applicant Name: Matt Teresi Applicant Title: Manager <br /> Applicant Address: PO Box 819 Lodi, CA 95241 City: Lodi <br /> Applicant Phone: (209) 200-0421 Applicant email: matt@teresienterprises.com <br /> Property Owner Name: John and Varene A.Teresi Family Lp <br /> Property Owner Address: PO Box 819 Lodi, CA 95241 City: Lodi <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): ,S'�' Acres to be Served by Well:1 p <br /> Use of Well: ❑Domestic ®Irrigation ❑Small Public Water Supply 17 Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): ) Estimated Pumping Rate(gal/min): 55�-4o <br /> Anticipated Pumping Schedule(gal/day): a6 e7r Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION' <br /> Total Number of Existing Wells on Property: 1 <br /> Please complete the information below for every well on property.Use extra paper if needed <br /> Well 91 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): j Open Bottom or-6ereemtntenrar(ftj. To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): j <br /> Other Pumping Tests Performdd: 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 />