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SAUOAQUIN <br /> <br />Environmental Health Department <br />---COUNTY--- <br />Greotne5S CI rOWS <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:*;.„ 7571 ilkt/tr 7/(' City: ,,,,,/,.., <br />Well Location APN:1, 696 .7.... ,;7_ o ) <br />Well Latitude: 3 if. Og s-i y Well Longitude: — I ?,0„q ‘ 2 75". <br />Flood Plain Designation: Well Elevation: ..,?.. c2 3 ,c,i_ <br />Applicant Name: A. 6c 3 Applicant Title: <br />Applicant Address: pc 1„,),, 17s) City: Wooc,(6 f, '‘,!.f. .4 <br />Applicant Phone: '90-, (4 7d-5 Applicant email: <br />Property Owner Name: 0 ( c.„,e eA OA /C5 /L. (.: <br />Property Owner Address: 1.4 y ip ace— id( City: 64 l I- <br />Property Owner Phone: (4 yg— 357 (--, Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): Acres to be Served by Well: <br />Use of Well: 0 Domestic KIrrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />0 Other: <br />Depth of Corcoran Clay (ft): /1/74 <br />Proposed Well Capacity (gal/ft): (.94'3/h Estimated Pumping Rate (gal/min): ,..,e.7.2 <br />Anticipated Pumping Schedule (gal/day): /??., 000 (./et / Estimated Annual Extraction Volume (acre-feet): /1.94, <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): 7 a <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on <br />Please complete the information below <br />Property: DO <br />for every well on property. Use extra paper if needed <br />Well #1 information <br />Use of Well: 0 Domestic ji(.Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply <br />0 Other: <br />0 Industrial 0 Stock <br />Total Depth (ft): <br />CI 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