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Gc, <br />SANAAQUIN <br />COUNTY <br />Greatness grows here. <br />Environmental Health Department <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: ,.a...zDs (v, Air f't, ri" t.st,t1 City: r'\ i < Well Location APN: i q'- 010 0 3s <br />Well Latitude: 1.7, CS 3 I 9 5 Well Longitude: i a, 1 • .),5 7 0147 <br />Flood Plain Designation: Well Elevation: al , <br />Applicant Name: amt. ,,,A1-.._.,- 0 r :11 1% Go Applicant Title:lax-- Applicant Address: -100 S , K.,..fro i R-A, City: --r,-- io Lk._ <br />Applicant Phone: -?-ook - 6 - ) S '2 5 Applicant email: c,,,, j-,— 117'. t Creick <br />Property Owner Name: C._ -k-,,,- Pa .F 0 py-r+.'e., -7-rv e- <br />Property Owner Address: I ceolf 5 ..,; QT Or, City: 0 kV-, iS r.0 k Property Owner Phone: Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): 3-0 (0 ' Acres to be Served by Well: as. <br />Use of Well: <br /> 0 Other: <br />0 Domestic Br lrhgation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />Depth of Corcoran Clay (ft): <br />Proposed Well Capacity (galift): I , .5- Estimated Pumping Rate (gal/min): ) S ce sts-P rn <br />Anticipated Pumping Schedule (gal/day): I a:c)c, Estimated Annual Extraction Volume (acre-feet): CrO.c.c. Zi <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on <br />Please complete the information below <br />Property: 0 <br />for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of Well: <br /> 0 Other: <br />0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />Total Depth (ft): <br />0 Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): To: From: <br />Pumping Rate (gpm): To: From: <br />Annual Extraction Volume (acre-feet: 0 Estimated 0 Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 l F 209 464-0138 I www.sjcend.com