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AL 'r° SA N.P10A Q U I N COUNTY 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. 4'-^.L�.' Well Location Address: V "r, C. x +aL SSEs " `� ., . .•k:t'e`r li�" r�. pn ;.,,. ;?�,a4:. C: .'L��n„r:+f�+�l. <. ..�!' city:1 1MADM. OOJ Well Location APN: sqi _ 1 Q ❑ Domestic Irrigation ❑ Other. Well Latitude: Depth of Corcoran Clay (ft): Well Longitude: Proposed Well Capacity (gal/ft): Flood Plain Designation: Anticipated Pumping Schedule (gal/day): Well Elevation: ' Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): To: - From: Applicant Name: To: Applicant Title: \l114 Applicant Address: Via 1104V city: N Applicant Phone: Applicant email: Specific Capacity (gal/min/ft): Property Owner Name: Property Owner Address: Other Pumping Tests Performed: City: Test Result: Property Owner Phone: Property Owner email: PRQPyQ$lE`}J64FtT.4S!�a R ©l\ "r, C. x +aL SSEs " `� ., . Well Total Depth (ft):1 IA JUU Acres to be Served by Well: 10 Use of Well: ❑ Domestic Irrigation ❑ Other. ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): Use of Well: Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gallmin): Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume (acre-feet): Al A Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): Tj P ;�� - Total Number of Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: ❑ Domestic ❑ 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, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com