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SAN JOAQUIN <br />{ <br />COUNTY— <br />Greatness grows her, <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 />Well Total Depthh(ft): to .00 Acres to be Served by Well: $ D <br />Well Location Address: <br />Well Location APN: <br />QJ'o.+w•./ <br />( -6 -1 _ e6 C) - 0 o%o <br />A v4 City: <br />S c-iL�''� <br />Well Latitude: 37, Id ala_ ] ? <br />Well Longitude: (.a1 , 3'3- C l <br />Flood Plain Designation: <br />Anticipated Pumping Schedule (gal/day): <br />Well Elevation: q <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: <br />Test Result: <br />Applicant Name: <br />f <br />Applicant Title: <br />Applicant Address: <br />3 oa S, �L ; (L, <br />City: <br />C of v <br />Applicant Phone: <br />Applicant email: <br />Property Owner Name: �v SSeI <br />Property Owner Address: E . A v aroma <br />Property Owner Phone: <br />City: <br />Property Owner email: <br />Q 0.'D may; bg ,r' 001. <br />PROPOSED WELL INFORMATION <br />Well Total Depthh(ft): to .00 Acres to be Served by Well: $ D <br />Use of Well: <br />❑ Domestic gyirrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Proposed Well Capacity (gal/ft): <br />_S Estimated Pumping Rate (gal/min): <br />Anticipated Pumping Schedule (gal/day): <br />1 p aoo Estimated Annual Extraction Volume (acre-feet): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />,1-1 - c.w <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: <br />❑ Domestic ❑ Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Total Depth (ft): <br />Casing Diameter (in): <br />Pumping Rate (gpm): <br />To: From: <br />❑ Open Bottom or Screen Interval (ft): To: From: <br />To: 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, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />