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SAN JOAQUIN C"Du\— 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. j WELL LOCATION AND OWNER INFORMATION Total Number of Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well Location Address: 3880 A pine Rd City: Stockton, CA Well Location APN: Depth of Corcoran Clay (ft): No 1A1E Well Latitude: 8 0 Well Longitude: Anticipated Pumping Schedule (gal/day): Flood Plain Designation: Estimated Annual Extraction Volume (acre feet): 6S Well Elevation: Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): Applicant Name: Prieto Famliy Trus Applicant Title:j owner Applicant Address: 2328 Brittany Lane City: lodi Applicant Phone: 209-482-6321 Applicant email: Property Owner Name: same Property Owner Address: City: Property Owner Phone: Property Owner email: PROPOSED WELL INFORMATION Total Number of Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well Total Depth (ft): p p Acres to be Served by Well: a'p Use of Well: O Domestic Xlrrigafion ❑ Other: ❑ Small Public Water Supply O Municipal Public Water Supply ❑ Industrial O Stock Depth of Corcoran Clay (ft): No 1A1E Proposed Well Capacity (gal/ft): 8 0 Estimated Pumping Rate (gal/min):1 5 t O Anticipated Pumping Schedule (gal/day): /32I D 0 D Estimated Annual Extraction Volume (acre feet): 6S Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): EXISTING WELLS INFORMATION Total Number of Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: O Domestic Nrrigation O Small Public Water Supply O Municipal Public Water Supply O Industrial ❑ Stock O Other: Total Depth (ft): 1] To: m T From: Su f.e )•Y O Open Bottom or Screen Interval (ft): To: 60 From: ye5 8 r>+k To: Casing Diameter (in): i.J Pumping Rate (gpm): 8 00 Annual Extraction Volume (acre-feet: cS ❑ Estimated >CMeasured Specific Capacity (gal/min/ft): D Sr. Other Pumping Tests Performed: _/Y&91Y Test Result: O e5 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com