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<br />SAN JOAQUIN Environmental Health Department <br />COUNTY <br />Greatness grows <br /> <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:426 , 6 #44,--,/ 0-- City: vio, c <br />Well Location APN: 625- / - Aio— e, 3 <br />Well Latitude: 7 , /3 770 Well Longitude: . -- 1d/ <br />Flood Plain Designation: Well Elevation: b/... • :/- <br />Applicant Name: i denif 6„2.5). 911/,,...,' , Applicant Title: <br />Applicant Address: ,p7 c,,e_ 17d7 City: /e/001.66 42- <br />Applicant Phone: -3 3 cy,...c../ z?.....3- Applicant email: <br />Property Owner Name: g; )/ B-e 0, A4,21A. <br />Property Owner Address: _c4,,,.e_ City: <br />Property Owner Phone: Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): Acres to be Served by Well: <br />Use of Well: 0 Domestic ,Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial <br />0 Other: <br />0 Stock <br />Depth of Corcoran Clay (ft): 4/A <br />Proposed Well Capacity (gal/ft): <br />\i/ <br />Estimated Pumping Rate (gal/min): Ni, <br />Anticipated Pumping Schedule (gal/day): 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 <br />Please complete the information below <br />Property: <br />for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of Well: 0 Domestic 0 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />0 Other: <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 T 209 468-3420 I F 209 464-0138 I www.sjcehd.com