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SAN JOAQUIN Enviro •. __ .ental Health Department -COUNTY-EXISTING WELLS INFORMATION Total Number Existinq Wells on Property:l 1 I Please complete the information below for every well on property. Use extra paper if needed. Well #1 Information Use of Well: !!!!!I Domestic D Irrigation D Small Public Water Supply □ Municipal Public Water Supply D Industrial D Stock D Other: Total Depth (ft): 100 + To: see permit From: Casinq Diameter {in): e Screen Interval (ft): To: From: Pumpinq Rate (qom): 20gpm To: From: Annual Extraction Volume (acre-feet: 3 acre-feet !!!!!I Estimated □ Measured Specific Capacity (gal/min/ft): NIA Other Pumping Tests Performed: inspected 2020 Test Result:! good Well #2 Information NIA Use of Well: D Domestic D Irrigation D Small Public Water Supply □ Municipal Public Water Supply D Industrial D Stock D Other: Total Depth (ft): To: From: Casing Diameter (in): Screen Interval {ft}: To: From: Pumping Rate (aom): To: From: Annual Extraction Volume (acre-feet: D Estimated D Measured Specific Capacity (qal/min/ft): Other Pumping Tests Performed: Test Result:! Well #3 Information Use of Well: D Domestic D Irrigation D Small Public Water Supply D Municipal Public Water Supply D Industrial □ Stock D Other: Total Depth (ft): To: From: Casing Diameter (in): Screen Interval {ft}: To: From: Pumping Rate (qpm): To: From: Annual Extraction Volume (acre-feet: D Estimated D Measured Specific Capacity (qal/min/ft): Other Pumping Tests Performed: Test Result:! MAP INFORMATION A must be attached to this form and shall include the followin information: 2of2