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1 <br /> C( <br /> ,D <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 .C, � L #/,-,rr , City: <br /> Well Location APN: 05 3i S-1;/, <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: 1� Applicant Title: � J <br /> Applicant Address: City: <br /> Applicant Phone: - ,� •_ G,��_ _3.. ,� I Applicant email: <br /> ...�22cun. cJ Yu � c�ys✓ <br /> Property Owner Name: ` L�/e <br /> Property Owner Address:: C�S57 1 City: <br /> Property Owner Phone: . 3 7 Property Owner email: �vx f% - , �mr /�x� Um, <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):I �C Acres to be Served by Well: <br /> Use of Well: ❑ Domestic .9 Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft):I ; <br /> Proposed Well Capacity(gal/ft): /V0 Estimated Pumping Rate(gal/min):) <br /> Anticipated Pumping Schedule(gal/day):I ti cc Estimated Annual Extraction Volume(acre-feet)] <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> I <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 WTeII: Domestic 11Irrigation ❑Small Public Water Supply C3 Municipal Public Water Supply El Industrial 11 Stock <br /> Other: <br /> Total Depth(ft): I To: From: <br /> Casing Diameter(in): ❑Open Bottom or�Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): I I To: From: <br /> Annual Extraction Volume(acre-feet: I ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed:I Test Result: <br /> '868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wwtnt.sjcehd.com <br />