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`tSANAMUIN Environmental Health Department <br /> tc�t` r Greatness grows herr <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 /> J <br /> t3i. > --„'P. a ..SMS"°'• <br /> Well Location Address: Z y City: Gy Cj� <br /> Well location APN: <br /> Well Latitude: Well Longi &- — <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Applicant Title: W <br /> Applicant Address: , N C &Ck <br /> Applicant Phone: Applicant email. <br /> Property Owner Name: . :. <br /> Property Owner Address: car <br /> Property Owner Phone: Property Owner ernal: <br /> Wel Total Depth(ft): Acres to be Served by Well: <br /> Use of Wel: ❑Domestic tion ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial 0 Stock <br /> ❑other <br /> Depth of Corcoran Clay(ft): <br /> ProposedWell Capacity(gam): Estimated Pumping Rate(gallmin): IM U <br /> ,e,ntcipaW Pumping Scmedule(galday):JU, Wj I Estimated Annual Extrac5on Volume(acre-feet) <br /> Estimated Curnulative Extrac bon Vokmme before January 1,2020(acre-feet) <br /> NNIFIN -,.vii.. -.,.» k - ? MM <br /> Total Number of Existing Webs on Property: _ 1 <br /> Please compleW ft k*rmation below for every well on property.Use extra paper if needed . <br /> wel#1 Nrform um <br /> use of Wel: ❑Domestic Irrigation Small Public Water Supply LiMunicipal Public Water Supply ❑Industrial ❑Stock <br /> I <br /> �00W. <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Saw Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Speck Capacity(gaUminl t): <br /> Other Pumping Tests Performed: Test Res <br /> 1868 E. Hazelton Avenue( Stockton,California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcchd.com <br />