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I`y SAN JOAQUIN LW t;zL -- O U N T Y greatness grows here 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 Total Number of Existing Wells on Property: eZ__ Please complete the information below for every well on property. Use extra paper if needed Well Location Address:� _ w City: Well Location APN: Well Latitud, Flood Plain Designation: „ 7 t/0 - v'} 3 1 0.Y 70 s Well Longitude: Well Elevation Depth of Corcoran Clay (ft): To: From: Casing Diameter (in): Proposed Well Capacity (gal/ft): Applicant Name:' ,f�'SS Applicant Title: %. Applicant Address: ��Ln �, 17 City: Applicant Phone: 37,AT Applicant email: Other Pumping Tests Performed: Test Result: Property Owner Name: Crd &c'o C;CKs Property Owner Address: � L� 06r: r�� City: 6j( f Property Owner Phone:_3 ' Property Owner email: PROPOSED WELL INFORMATION Total Number of Existing Wells on Property: eZ__ Please complete the information below for every well on property. Use extra paper if needed Well Total Depth (ft): I Acres to be Served by Well: Use of Well: ❑ Domestic Airrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): To: From: Casing Diameter (in): Proposed Well Capacity (gal/ft): z=� ��,+�� Estimated Pumping Rate (gal/min): ��x� Anticipated Pumping Schedule (gal/day): %. Estimated Annual Extraction Volume (acre-feet): iG?6 Estimated Cemulative Extraction Volume before January 1, 2020 (acre-feet): 3 V EXISTING WELLS INFORMATION Total Number of Existing Wells on Property: eZ__ Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: ❑ Domestic A Irrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ 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: Test Result: 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com