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SAN J OAQ U I N 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: 30222 N Mackville Rd, City: Galt Well Location APN: 00917o09 ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Well Latitude: Well Longitude: Proposed Well Capacity (gal/ft): Flood Plain Designation: Well Elevation: 1 D Opo Estimated Annual Extraction Volume (acre-feet): p From: Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): Applicant Name: Vista Del Sol Vineyards, LLC Applicant Title: cu rr Applicant Address: PO Box 1 743 City: Lodi Applicant Phone: 209-642-34 3 3 Applicant email: l i nd a@ pbm 1 od i, com Annual Extraction Volume (acre-feet: ❑ Estimated ❑ Measured Property Owner Name: Same Property Owner Address: City: Property Owner Phone: Property Owner email: Test Result: PROPOSED WELL INFORMATION Well Total Depth (ft): e0 25 Acres to be Served by Well: Use of Well: ❑ Domestic 7g Irrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): Y A Proposed Well Capacity (gal/ft): 50 Estimated Pumping Rate (gal/min): / oo 0 Anticipated Pumping Schedule (gal/day): 1 D Opo Estimated Annual Extraction Volume (acre-feet): p From: Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): EXISTING WELLS INFORMATION Total Number of Existing Wells on Property: /K CJ Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Other: ❑ Industrial ❑ Stock Total Depth (ft): ❑ Open Bottom or Screen Interval (ft): To: From: Casing Diameter (in): To: From: Pumping Rate (gpm): To: From: Annual Extraction Volume (acre-feet: ❑ Estimated ❑ Measured Specific Capacity (gal/min/ft): Other Pumping Tests Performed:1 Test Result: 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.coni