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SANAOAQUIN <br />{ --COUNTY <br />Greotness grows here <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 />Well Total Depth (ft): <br />Well Location Address: <br />-7 w 0 <br />Icity-.1 <br />e <br />Well Location APN: <br />Well Latitude <br />Flood Plain Designation: <br />7 _ ?;o _ ..3 <br />��", c� rj(yt'�'� <br />Well Longitude: — rZU 7F,2 1 <br />Well Elevation: <br />Applicant Name: <br />��5 <br />Applicant Title: <br />Casing Diameter (in): <br />Applicant Address:L� <br />�� <br />City: <br />To: <br />Applicant Phone: <br />C/ 7zXT <br />Applicant email: <br />Specific Capacity (gal/min/ft): <br />Property Owner Name: <br />(jG�� Cj6tK5- <br />Test Result: <br />Property Owner Address: <br />, e? 06- r -A <br />City: <br />Property Owner Phone: <br />IV_3 -7 6 <br />1 Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): <br />Acres to be Served by Well: <br />Use of Well: <br />❑ Domestic KImgation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Total Depth (ft): <br />Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): ;2ex.? <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): lee <br />E� <br />Casing Diameter (in): <br />Estimated umulative Extraction Volume before January 1, 2020 (acre-feet): -> 0' <br />EXISTING WELLS INFORMATION <br />it <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 />Use of Well: <br />❑ Domestic A Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply <br />❑ Other: <br />❑ Industrial ❑ Stock <br />Total Depth (ft): <br />❑ Open Bottom or Screen Interval (ft): <br />To: <br />From: <br />Casing Diameter (in): <br />To: <br />From: <br />Pumping Rate (gpm): <br />To: <br />From: <br />Annual Extraction Volume (acre-feet:1 <br />❑ Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: <br />Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />