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�r�° " <br /> '� Environmental Health Department <br /> !111 —COUNTY— <br /> 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 <br /> known. The Environmental Health Department must collect this information before a new well <br /> permit is issued and must post the information on the Department's website for public information. <br /> WELL;LOCATION' NER:INF.ORMATION- ::_• <br /> Well Location Address: City MKIMUN <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: !} <br /> Applicant Name: Applicant Title: r( <br /> Applicant Address: '] City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: _ <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> 7777 <br /> PROPOSED.WELCINF.ORMATION: <br /> Well Total Depth(ft): r Acres to be Served by Well: <br /> Use of Well: <br /> ❑ DomesticIrrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gaUmin): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): a <br /> Estimated Cumulative Extraction Volume before January 1. 2020(acre-feet): <br /> EXISTING.WELLS`INFORMATION. '�� �;;iv ... <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 /> ❑ DomesticIrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑Industdal ❑Stock <br /> ❑Other. <br /> Total Depth(ft): To: From: <br /> Casing Diameter(n): ❑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/minlft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />