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SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COU NTY <br />Grectney. grows <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: :).. -7 57/ ii 14.,-y. 2 4 City: ( , <br />Well Location APN: e.) 6 .7— ;_ y 0 - e.)) <br />Well Latitude: 3 g. 07917 Well Longitude: — )Ao, 9(.., 5;- 7 <br />Flood Plain Designation: Well Elevation: / yf <br />Applicant Name: k, , .i.4 6,fa c 3 Applicant Title: <br />Applicant Address: po 44,,,.. I 7' City: wood6,,f(4.0 <br />Applicant Phone: -330_ ti 7a...5- Applicant email: <br />Property Owner Name: ck,,( 6,0 1:4-A OA k5 1 I., (..: <br />Property Owner Address: ti no Orr- IA City: 6 l 4. 4 <br />Property Owner Phone: e_i y Property Owner email: g — 3574, <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): 4/A <br />Proposed Well Capacity (gal/ft): z.n/ ern-, Estimated Pumping Rate (gal/min): 1,(—X2 <br />Anticipated Pumping Schedule (gal/day): ii01.1 000 &At Estimated Annual Extraction Volume (acre-feet): /62 .6 <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): 2 11.Y' <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on <br />Please complete the information below <br />Property: 3l <br />for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of Well: 0 Domestic )(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 209 468-34201 F 209 464-0138 I www.sjcelici.com