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E4010- U14 r SAN.JOAQUIN I—COUNTY— ,q COUNTY— ,qc,+P Greatness or ws here. Environmental Health Department New Well Information Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit the following required information, to the extent that can be reasonably known. The Environmental Health Department must collect this information before a new well permit is issued and must post the information on the Department's website for public information. WELL LOCATION AND OWNER INFORMATION Well Location Address: 1 City: fAwNCINK Acres to be Served by Well: LIU Well Location APN: — _210 J ❑ Domestic Irrigation ❑ Other. Well Latitude: Well Longitude: q54 01,1 - Flood Plain Designation: Well Elevation: Estimated Pumping Rate (gal/min): Anticipated Pumping Schedule (gal1day): To: Applicant Name: Applicant Title: tiJ Applicant Address: City: Applicant Phone: Applicant email: Annual Extraction Volume (acre-feet Property Owner Name: Property Owner Address: City: Property Owner Phone: Property Owner email: PROPOSED WELL INFORMATION Well Total Depth (ft): Total Number of-ExOAtmg Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Acres to be Served by Well: LIU Use of Well: ❑ Domestic Irrigation ❑ Other. ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): ❑ Domestic 1krigation ❑ Other: Proposed Well Capacity (gal/ft): Total Depth (ft): Casing Diameter (in): Estimated Pumping Rate (gal/min): Anticipated Pumping Schedule (gal1day): To: Estimated Annual Extraction Volume (acre-feet): El To: Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): EXISTING WELLS INFORMATION Total Number of-ExOAtmg Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: ❑ Domestic 1krigation ❑ Other: ❑ Small A160c Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Total Depth (ft): Casing Diameter (in): ❑ Open Bottom or Screen Interval (ft): To: From: To: From: Pumping Rate (gpm): To: From: Annual Extraction Volume (acre-feet ❑ Estimated ❑ Measured Specific Capacity (gallmin/ft): Other Pumping Tests Performed: Test Result: 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com