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lv c. <br /> • r� <br /> S A N�j O A Q U I N Environmental Health Department <br /> COUNT Y <br /> Greatness grows here. <br /> New Well Information 11 <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: 21 O t. 5 , 'ne or. I City: ar' +cco, <br /> Well Location APN: 2_16 —Oct O—0Z <br /> Well Latitude: 1 2,f3 Well Longitude: 2 ` ,Z 9,5 <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: VA fm ; fir,• n �w Applicant Title: <br /> Applicant Address: `ata City: 6.x-.0 <br /> Applicant Phone: CJt�CJ_� Applicant email: .11,54UtoC»in <br /> bras. C.o r+� <br /> Property Owner Name: . Cry Flo M C5 a o ir n,I a Sn C <br /> Property Owner Address:BW `1 W a�1 C r rJ�"C CityS V C r <br /> Property Owner Phone: G Oft"C Property Owner email: KG a Co <br /> l0 �nC. C.oM <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I2,p0� Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): t- <br /> Proposed Well Capacity(gal/ft): 5D0 Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): 0 <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 0 <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth (ft): To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: Q 1 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />