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SAN JOAQUIN <br />-- <br />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: Vl <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well Location Address: me✓- 0 C. G,-aved <br />S. pec City: <br />Well Location APN: _76._ <br />❑ Domestic )(Irrigation <br />❑ Other: <br />Well Latitude: o L <br />Well Longitude: I ezo g W <br />Flood Plain Designation: <br />Well Elevation: <br />❑ Estimated ❑ Measured <br />Estimated Pumping Rate (gal/min): <br />Applicant Name: USN D o <br />Applicant Title: /tiiac+a <br />Applicant Address: 12 <br />City: <br />Applicant Phone: 20 —595-1956 6 <br />Applicant email: <br />Property Owner Name: wms4ivwl' <br />a <br />Property Owner Address: 12,10 o E , G <br />.111 <br />Property Owner Phone: — R 564 <br />Property Owner email: <br />PROPOSED WELL INFORMATION <br />Total Number of Existing Wells on Property: Vl <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well Total Depth (ft):1 I <br />Acres to be Served by Well: 29' <br />Us7ofWell <br />❑ Domestic )(Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Pumping Rate (gpm): 25 503f <br />Proposed Well Capacity (gal/ft): <br />❑ Estimated ❑ Measured <br />Estimated Pumping Rate (gal/min): <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on Property: Vl <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Information <br />Use of WellP11:3 <br />Domestic �lrrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply E]Industrial ❑ Stock <br />Other: <br />Total Depth (ft): V N 100 <br />n To: L&J<raur From: "kv-w- <br />❑ Open Bottom or Screen Interval (ft): To: From: <br />wt To: From: <br />Casing Diameter (in): a <br />Pumping Rate (gpm): 25 503f <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): u <br />w <br />Other Pumping Tests Performed: yt 0-yLa, C W P a VCbAg tN Test Result: <br />k/e,l l 1S joIJ�a II c j�„ <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br />