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S A N J O A Q U I N 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 />Total Number of Existing Wells on Property: 16114' loyll, <br />Please complete the information below for every well on property. Use extra paper if needed <br />I Well Location Address:188 1 r a z i e r <br />City: inden <br />Well Location APN: 0 6 51 5 01 1 <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Well Latitude: <br />Well Longitude: <br />Proposed Well Capacity (gal/ft): <br />Flood Plain Designation: <br />Well Elevation: <br />Anticipated Pumping Schedule (gal/day): <br />3 $ Ll © o o <br />I Estimated Annual Extraction Volume (acre-feet): D <br />Applicant Name: Prieto Family Trust <br />& Paul Wo plicantTitle: owner <br />Applicant Address: 2328 Brittany Lane <br />City: Lodi, CA 95242 <br />Applicant Phone: 2 0 9— 4 8 2— 6 3 21 <br />Applicant email: <br />Property Owner Name. same <br />Property Owner Address: <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />PROPOSED WELL INFORMATION <br />Total Number of Existing Wells on Property: 16114' loyll, <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well Total Depth (ft):1 coo Acres to be Seared by Well: Q <br />Use of Well: <br />❑ DomesticIrrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />IV6)f <br />Proposed Well Capacity (gal/ft): <br />/ a O <br />1 Estimated Pumping Rate (gal/min): Pbb <br />Anticipated Pumping Schedule (gal/day): <br />3 $ Ll © o o <br />I Estimated Annual Extraction Volume (acre-feet): D <br />i <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): --- <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on Property: 16114' loyll, <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Information NON,! 5,7 <br />=0f❑Dom <br />Elestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industria ❑ Industriall Stock <br />03Other: <br />Total Depth (ft): <br />❑ Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): <br />To: From: <br />Pumping Rate (gpm): <br />To: From: <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed:1 <br />Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464.-0138 1 www.sjcehd.com <br />