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SAN JOAQUIN , 1 646 <br />Er <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: :2 -75// 1.-i CitY: i i„,..,-./ ,,,/. k, e ,. /..,,-, <br />Well Location APN: 0 6 -7_ c )._ ca) <br />Well Latitude: 3y, o19.19 Well Longitude: <br />Flood Plain Designation: Well Elevation: <br />Applicant Name: e , 62,--vc 3 K A Applicant Title: a, d e /- <br />Applicant Address: Po i.„,,,,, I 760 City: G.4,006164 C-4 4.2 <br />Applicant Phone: -33(1/ 0 7 5- Applicant email: <br />Property Owner Name: 0 c„( &ad C A /C5 It. C <br />Property Owner Address: z." yio act-- ,at. City: 64 ( 1 <br />Property Owner Phone: Li yg— 35 -7 (.., 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 El Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial El Stock <br />0 Other: <br />Depth of Corcoran Clay (ft): 4/14 <br />Proposed Well Capacity (gal/ft): c."41_9"/(il, Estimated Pumping Rate (gal/min): c.,6,Y-2 <br />Anticipated Pumping Schedule (gal/day): /id./ ()00 (vet I Estimated Annual Extraction Volume (acre-feet): jo 4, <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): 3 a <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on <br />Please complete the information below <br />- Property: 3 )-- <br />for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of Well: 0 Domestic ,KIrrigation D 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