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S A NJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> F . <br /> � L;F � Greatness grows here. <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 /> tlllL LO' t}I fl l" J <br /> K. <br /> E <br /> Well Location Address: .2s-,Ito S G�����j ,�, �/ City: �a <br /> Well Location APN: /,9 —,p ew <br /> Well Latitude: Well Longitude: /;t1—;? 3- 3/..3'a w <br /> Flood Plain Designation: Well Elevation:1 6 <br /> Applicant Name: Applicant Title: <br /> Applicant Address: /y3 s,r City: 4? 37,0 <br /> Applicant Phone: A,* Applicant email: e So46/?,e114.v4 P�IJIAr( <br /> Property Owner Name: 0e F/uo4S <br /> Property Owner Address: o Sc NV rf 4 74> <br /> • City: �jt� <br /> j <br /> Property Owner Phone:kv.3;/ _ p peRoe4 Property Owner email: <br /> PRO�? SEDIVf� 01ZTIC?i <br /> TM � <br /> Well Total Depth(ft)TT5 110 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic A Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): E�' -�' <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): yDo <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): ZglC> <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> IC .:EX US <br /> E , <br /> : > <br /> 11 <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: ❑ Domestic 4 Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): 500 To: From: <br /> Casing Diameter(in): /b t Open Bottom o Screen Interval( ; To: From: <br /> Pumping Rate(gpm): Soo -/PM To: From: <br /> Annual Extraction Volume(acre-feet: 2 ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: N / 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 />