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SAN JOAQUIN <br /> � i Environmental Health Department <br /> fI ---COUNTY <br /> c1QFoa�P Greatness grows her <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:' }� ��A� A City (Z , a N <br /> Well Location APN: aaA 110 tj <br /> Well Latitude:) 3-77 q 00 5 Well Longitude: , I N j S ;L_e5- <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: elly Applicant Title: R N /— <br /> Applicant Address: 30o S, ro City T� o <br /> Applicant Phone: _ -� _ `� a_ Applicant email: <br /> co <br /> Property Owner Name: <br /> Property Owner Address: a 3 �S S K,Jo� -Q City: <br /> Property Owner Phone: y 5 t,_ -�5 Property Owner email:�5 L r k I AOL <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 3-n Acres to be Served by Well: .: <br /> Use of Well: omestic 11 Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply 11 Industrial :1 Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): I Estimated Pumping Rate(gal/min): j S <br /> Anticipated Pumping Schedule(gal/day): goo Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): ) cl <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: omestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> _ ❑ Other: _ <br /> Total Depth(ft): 13o To: qo From: 130 <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): I S5 To: From: <br /> Annual Extraction Volume(acre-feet: ), q [!?�stimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: i't9 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 />