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� �° c SAN,J0A0UIN Department <br /> Environmental Health De <br /> � ' COUNTY— <br /> °1ci�oRe�t1 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 /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: 14 O N, fy\., ", S City: <br /> Well Location APN: -;).(q t oo0 3 <br /> Well Latitude: 1-7, y IS 9 6% Well Longitude: ta.\, �.�y a f a. <br /> Flood Plain Designation: Well Elevation: 3 <br /> Applicant Name: � }G A L w r,') Applicant Title: t 11 a-jCL of <br /> Applicant Address: . City: v r I o <br /> Applicant Phone: ap b 6 a Applicant email: <br /> Property Owner Name: r� A ��L <br /> Property Owner Address: ro G ` a(,p City: 2 a e 1 <br /> Property Owner Phone: q ( b _�-� _ p Property Owner email: Cly' <br /> 5 <br /> PROPOSED WELL INFORMATION Cam <br /> Well Total Depth(ft): 1 O D' Acres to be Served by Well: <br /> Use of Well: ❑ Domestic rrigation 13 Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial El Stock <br /> Use of WNeTll-: <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 1.9 Estimated Pumping Rate(gal/min): -3 op <br /> Anticipated Pumping Schedule(gal/day): *tA 1,-S I 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: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: 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 />