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SANAAQ IN �4 COUNTY 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: Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Well Total Depth (ft):i I D Well Location Address: :, -D �r�a Q City: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Well Location APN: Proposed Well Capacity (gal/ft): f ,5 Estimated Pumping Rate (gal/min): i�) Well Latitude:�7 Well Longitude: ) 20 , ► 4 b S a - Flood Plain Designation: Well Elevation: 1p 3 Applicant Name: Applicant Address: Applicant Phone: 3 O' \ r o FZ j to b � �� 3a\ Applicant Title: City: Applicant email:\ a Property Owner Name: R v�1, G N Property Owner Address: t 3 y a �... �aii Property Owner Phone: S y 1 - 3 Property Owner �r�)t7 y PROPOSED WELL INFORMATION 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 Well Total Depth (ft):i I D o' Acres to be Served by Well: 1 Use of Well: ❑ Domestic rrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): To: From: Proposed Well Capacity (gal/ft): f ,5 Estimated Pumping Rate (gal/min): i�) Anticipated Pumping Schedule (gallday): FT i Estimated Annual Extraction Volume (acre-feet): Specific Capacity (gal/min/ft): 5 Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): 71at, I , G- O" -- EXISTING WELLS INFORMATION 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 ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other: Total Depth (ft): 20Ac:> ❑ Open Bottom or Screen Interval (ft): To: From: Casing Diameter (in): Pumping Rate (gpm): ZD To: From: To: From: Annual Extraction Volume (acre-feet: 'j . ❑ Estimated ❑ Measured Specific Capacity (gal/min/ft): 5 Other Pumping Tests Performed: Test Result: 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com