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30 <br />SAN OAQUIN <br />---- COUNTY— <br />Greatness <br />OUNTYGreatness 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: <br />, <br />City: n <br />Weil Location APN: <br />Well Latitude:8, <br />Flood Plain Designation: <br />6 7_ 1q4) - &3 <br />� 97 <br />Well Longitude -- /� / . �6 6 J <br />Well Elevation -/9(. ,rt <br />A.pplicantName: <br />)( ;,e ��c75f <br />Applicant Title: D1,`1/&._ <br />Applicant Address: <br />P0 A17 <br />City: (vim p <br />Applicant Phone: <br />34,1 _ U 7,1$- <br />Applicant email: <br />Pumping Rate (gpm): <br />To: <br />Property Owner Name: <br />C9j 601ddC< j <br />C. <br />Property Owner Address: <br />V 962 0 ly- <br />City: <br />Property Owner Phone: <br />Y._ 5- 6 <br />Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): Acres to be Served by Well: <br />Use of Well: <br />❑ Domestic irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />P14. <br />Proposed Well Capacity (gal/ft): <br />O v czn- <br />Estimated Pumping Rate (gal/min): c � <br />Anticipated Pumping Schedule (gal/day): <br />exp d,,l <br />Estimated Annual Extraction Volume (acre-feet): d(, <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): ' /9 1 <br />EXISTING WELLS INFORMATION <br />Q <br />Total Number of Existing Wells on Property: a <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #€1 Information <br />Use of WelE.-Lo, <br />Domestic ElIrrigation <br />Other. <br />ElSmall Public Water Supply ElMunicipal Public Water Supply 11Industrial ❑ Stock <br />Total Depth (ft): <br />❑ Open Bottom or Screen Interval (ft): <br />To: <br />From: <br />Casing Diameter (in): <br />To: <br />From: <br />Pumping Rate (gpm): <br />To: <br />From: <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gallminlft): <br />Other Pumping Tests Performed:1 <br />Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />