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SANJ O A Q U I N Environmental Health Department COUi�,ITY EXISTING WELLS INFORMATION Total Number Existing Wells on Property:1 3 1 Please complete the information below for every well on property.Use extra paper if needed. Well#1 Information Use of Well: IN Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock ❑Other: Total Depth(ft): 335 To: 295 From: 335 Casing Diameter(in): 8 Screen Interval(ft): To: From: Pumping Rate m: 150 To: From: Annual Extraction Volume(acre-feet: 140 N Estimated ❑ Measured Specific Capacity( al/min/ft Other Pumping Tests Performed:1 Test Result: Well#2 Information Use of Well: ®Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock ❑Other: Total Depth(ft): 317 To: 297 From: 317 Casing Diameter(in): 8 Screen Interval(ft): To: From: Pumping Rate( pm): 150 To: From: Annual Extraction Volume(acre-feet: 140 Estimated ❑ Measured Specific Capacity al/min/ft Other Pumping Tests Performed: 1 Test Result: Well#3 Information Use of Well: ❑ Domestic IN Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock ❑Other: Total Depth(ft): 380 To: 248 From: 260 Casing Diameter in): 16 Screen Interval(ft): To: From: Pumping Rate g m: 1250 To: From: Annual Extraction Volume(acre-feet: 0 (back up well) & Estimated ❑ Measured Specific Capacity(gal/min/ft): Other Pumping Tests Performed:1 None Test Result: MAP INFORMATION A project site map must be attached to this form and shall include the following information: • Legal lot and parcel dimensions. • All well locations on legal lot and parcel with type and use information shown for each well. • All onsite sewage treatment systems,stormwater ponds,process water ponds,and other sources of potential contamination. • Distance from proposed well to any potential sources of pollution onsite and on adjacent proper-ties,including: o Existing or proposed onsite sewage treatment systems,wells,animal or fowl enclosures,transmission lines,sewer lines. o Distance from ponds,lakes, rivers and streams within 300 feet and navigable water ways within one mile. o For wells below Corcoran clay,map must show location of canals,ditches,pipelines,utility corridors,and roads within two miles. 2at2