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SAN J O A Q U I N Environmental Health Department c fa COUNTY Greatness grows here. 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 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: 70 1 N Esca on Be ota R City: Linden,CA 95236 Well Location APN: ()93U �olD To: Well Latitude: �— Well Longitude: � � Estimated Pumping Rate (gal/min): f Flood Plain Designation: (c%2 Estimated Annual Extraction Volume (acre-feet): Well Elevation: Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): From: Annual Extraction Volume (acre-feet: A Applicant Name: Gerlomes, Croce, DeMartini Applicant Title: owners Applicant Address: dba Creekside 8464 N DeMart'ni Rd City: Linden Applicant Phone: Applicant email: 011 � Test Result: 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): �, z! Acres to be Served by Well: Use of Well: ❑ Domestic 1A Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock 4), as � ❑ Other: To: Depth of Corcoran Clay (ft): �— Proposed Well Capacity (gaVft): � � Estimated Pumping Rate (gal/min): f Anticipated Pumping Schedule (gal/day): (c%2 Estimated Annual Extraction Volume (acre-feet): So 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: X Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other: Total Depth (ft): 4), as � NOpen Bottom or Screen Interval (ft): To: From: Casing Diameter (in): S To: From: Pumping Rate (gpm): So To: From: Annual Extraction Volume (acre-feet: A ❑ Estimated ❑ Measured Specific Capacity (gal/min/ft): , k(c oculi Other Pumping Tests Performed: 011 � Test Result: 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com