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'SAN 10AQUIN <br />COUNTY <br />Grectness grows here. <br />Environmental Health Department <br />49 <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 S z <br />City: <br />Well Location APN: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Well Latitude: '3 .7 cd O <br />Well Longitude: <br />I <br />Flood Plain Designation: <br />I Well Elevation: <br />Anticipated Pumping Schedule (gal/day): <br />oyes <br />Applicant Name: r <br />Applicant Title: p w ,j vr- <br />Applicant Address: 3 2 <br />City: v, . c CYN <br />Applicant Phone:b aC3 <br />Applicant email: Q j r,,k <br />r <br />Property Owner Name: s <br />Property Owner Address: <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft):' I as cv Acres to be Served by Well: , 3 <br />Use of Well:'Domestic <br />❑ Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Proposed Well Capacity (gal/ft): <br />T3 Q <br />Estimated Pumping Rate (gal/min): <br />Anticipated Pumping Schedule (gal/day): <br />oyes <br />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: <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of Welt. Domestic ❑ Irrigation ❑ Small Public Water Supply 11Municipal Public Water Supply ❑ Industrial ❑ Stock <br />❑ Other: <br />Total Depth (ft): oTo: N fl From: <br />Casing Diameter (in): to ' ❑ Open Bottom or Screen Interval (ft): To: From: <br />Pumping Rate (gpm): s To: From: <br />Annual Extraction Volume (acre-feet: J flan, Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): a p <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 />