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SAN <br /> s10A Q U I N Environmental Health Department <br /> I ` COUNTY- <br /> PFO <br /> ,� <br /> FOR'i�.'' Greatness grows here. <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 /> v-..�.- .y :a- 4Sr <br /> Well Location Address: ,Z�,z 2q n/. F�rPa� Q u I City: ,&A/ 4'0.9Sa'Ib�-Q7 <br /> Well Location APN: <br /> Well Latitude:-,7_/T 72 j3 Well Longitude: 37°-Stb 6V 8 <br /> Flood Plain Designation: Well Elevation: 417 <br /> Applicant Name: k1CX (_'AAf0 17,4 Applicant Title: 7P,,c si/)E iv T <br /> Applicant Address: 5A q ve S 1-k CT- • City: OND,e/q <br /> Applicant Phone: (apq 3 7- _/i3(P Applicant email: ,FOIL. AY <br /> Property Owner Name: 9bjO /-1EivGEd691.0 <br /> Property Owner Address: 5T - I 1#,*vTe4-City: �4 . <br /> Property Owner Phone: (,Zpq)Q(,p _;:to $o Property Owner email: ere She coal <br /> _P_ROPOSED WELL.INFORM <br /> Well Total Depth(ft): Alm o" Acres to be Served by Well: �$, <br /> Use of Well: ❑ Domestic XIrrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: Q,F,t c.s,- r n <br /> Depth of Corcoran Clay(ft): 5rfs w--, Ivo 0-09A�PzAov C r s �4.eE� A'"r 42 <br /> Proposed Well Capacity(gal/ft): 6-0elro boo-07* Estimated Pumping Rate(gal/min): Sroo <br /> + Anticipated Pumping Schedule(gal/day):2_5v,o Estimated Annual Extraction Volume(acre-feet): 88 A F <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): o <br /> XiS711Y�7 '$ , 3RWAM0lrs�,� nt_ <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 1A1 <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: 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 />