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t�aa`,, SAN�JOAQUIN Environmental Health Department <br />!'r `! —COUNTY <br />Greatness grows fere. <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 <br />known. The Environmental Health Department must collect this information before a new well <br />permit is issued and must post the information on the Department's website for public information. <br />WELL,LO:CATIOIN!AND O1difNE ,IN 0R1 lONt ` .. <br /><• s� ..:;... :t::. . <br />Well Location Address: I, <br />City: (,v <br />Well Location APN: — 0 —QUO <br />❑ Small Public Water Supply [IMunicipal Public Water Supply ❑ Industrial ❑ Stock <br />Well Latitude: <br />Well Longitude: <br />Proposed Well Capacity (gaVft): <br />Flood Plain Designation: <br />Well Elevation: <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Applicant Name: <br />Applicant Title: <br />Applicant Address: <br />City: <br />Applicant Phone: —t} <br />Applicant email: <br />Property Owner Name: <br />Property Owner Address: <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />PROPOS,ED:WELC INFQIM,TIPN = k " <br />Well Total Depth (ft):1 I <br />Acres to be Served by Well: <br />Use of Well: <br />❑ Domestic I Irrigation <br />!� Othe <br />El Other <br />❑ Small Public Water Supply [IMunicipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />To: From: <br />Proposed Well Capacity (gaVft): <br />Estimated ❑ Measured <br />Estimated Pumping Rate (gal/min): <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Other Pumping Tests Performed: <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EkSt'ING ty■�{,E� ���$J'NFO TIA'rys ' r :ftp , meg . <br />{r.,!. . ���7M7K'. `!1R�jx�l:V1Q;t .3i �! w�tR �tG:`i.�fH.W.w r.�i.-. DL.'tx'.�JiM°��t$`rmµ,. i. psi <br />Total Number of Existing Wells on Property: <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Information . <br />❑ Domestic Irrigation ❑Small Public Water Supply ❑ nicipa] Public Water Supply ❑ Industrial ❑ Stock <br />Use of Well: <br />❑ Other. <br />Total Depth (ft): <br />Casing Diameter (in): <br />Pumping Rate (gpm): <br />❑ Open Bottom or Screen Interval (ft): <br />To: From: <br />To: From: <br />To: From: <br />Annual Extraction Volume (acre-feet: <br />Estimated ❑ Measured <br />Specific Capacity (gaVmin/ft): <br />Other Pumping Tests Performed: <br />Test Result: <br />1868 E. Hazetton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />