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f <br /> SAN�JOAQUIN p <br /> ' Environmental Health Department <br /> COUNTY <br /> c"gLf�Fpp�p` rtL':Jti�d;5 c��Gt45 rll?+�. <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 Location Address: I City: 1� <br /> Well Location APN: Q — «— <br /> Well Latitude: Z 27__3 1 Well Longitude: .—j L , —j <br /> Flood Plain Designation: I Well Elevation:1 10, <br /> Applicant Name: f,0 U QHS 1XVj2 _ Applicant Title: p N <br /> Applicant Address: Z Z by IPA City: f5cmaloN, fAq ?gyp <br /> Applicant Phone: 3. E) - '2:0' Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: ❑Domestic Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other. <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(galfft): Estimated Pumping Rate(galimin): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <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 ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑open Bottom or screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet S Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />