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Q� SAN 10AQUIN <br />.°:w` ? , ----COUNTY--- <br />c4t„ F Greotness grows here. <br />Environmental Health Department <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 />Total Number of Existing Wells on Property: i <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well Total Depth (ft):1 <br />Well Location Address: Z,'i 0 0 fA rCity: <br />Soo, Acres to be Served by Well:1 4o <br />Tr <br />Well Location APN: Z3� . 0!50— t °j <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Well Latitude: ij"'1, "� g rJ� 9 <br />Well Longitude.- <br />ongitude:Flood <br />Estimated Pumping Rate (gal/min): G54. 1 1000 <br />Anticipated Pumping Schedule (gal/day): <br />FloodPlain Designation: <br />Well Elevation:) <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />Z� <br />Specific Capacity (gal/min/ft): <br />Applicant Name: r. &a's . <br />V'r Vk Y\Cx, Applicant Title: <br />Other Pumping Tests Performed: <br />Applicant Address: \ ct 3City: <br />Applicant Phone: 45 _L <br />Applicant email: <br />nii 40 <br />bras. Conn <br />Property Owner Name: C O 1 <br />Property Owner Address: 711 L t Is a <br />1 City: <br />,040J CA Q <br />Property Owner Phone: 24D 4L . 7 b <br />Property Owner email: <br />a� <br />n n 1 - C r)w% <br />PROPOSED WELL INFORMATION <br />Total Number of Existing Wells on Property: i <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well Total Depth (ft):1 <br />I <br />Soo, Acres to be Served by Well:1 4o <br />Use of Well: <br />❑ Domestic Xrrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Casing Diameter (in): 611 <br />Proposed Well Capacity (gallft): <br />Estimated Pumping Rate (gal/min): G54. 1 1000 <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />From: <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on Property: i <br />Please complete the information below for every well on property. Use extra paper if needed <br />Well #1 Infonnation <br />Use of Well: <br />Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />❑ Other: <br />Total Depth (ft): 10 0 <br />❑ Open Bottom or Screen Interval (ft): <br />To: <br />From: <br />Casing Diameter (in): 611 <br />To: <br />From: <br />Pumping Rate (gpm): <br />To: <br />From: <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: <br />Test Result: <br />1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />