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' ptls'h <br /> SA N,J OAQ U I N Environmental Health Department <br /> "4 •�r-� 2 <br /> COUNTY— <br /> c��rapai+*" 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 <br /> public information. <br /> P .l�Yiq Y A <br /> Well Location Address: S MAI D1 I City: <br /> Well Location APN: 2 <br /> Well Latitude: Well Longitude: _ ;� . <br /> Flood Plain Designation: WeIIEL-vation:l Mul <br /> Applicant Name: r Applicant Title: <br /> Applicant Address: City: h R —6 <br /> Applicant Phone:�91N- Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> W. <br /> WeN Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: ❑Domestic XIrtigabw ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depttt of Corcoran Clay(d): <br /> Proposed Well Capa*(gd*): Esdmabed Pumping Rabe(gam): U0 <br /> Anticipated Pumping Schedule(pVday): Estimated Annual Extra0w Volume(acre-feet) 1•I <br /> Estimated Cu five Extraction Volume before January 1,2020(acre-fillet):AtJ <br /> MOON! sLF{4,��1���. �p' 1 �� } �A`.4��::.v.4.: <br /> 7TTotal Number of Existing Wells on Property: ,VM 0 (b <br /> Please complete the information below for every well on property.Use extra paper if needed <br /> Wd f1 Information <br /> Use of Well: ❑Domestic ❑Irrigation ❑Smd Public Water Supply ❑ Munbo Public Water Supply ❑Industrial ❑Stock <br /> _] <br /> ❑Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rabe(gpm): To: From: <br /> Annual Extraction Volume(acre-feet ❑ Estimated ❑ Measured <br /> Capacily(pVffm ft): <br /> Other Pumping Tests Performed: Test Result <br /> 1868 E. Hazelton Avenue 1 Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />