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r . <br /> SAN)JOAHIN Environmental Health Department <br /> —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 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 Addns: City: <br /> Well Location APN: _ 1 <br /> Well Latitude: mIt <br /> Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Aunt Tree: QW <br /> Applicant Address: .0. City: 10M il <br /> Applicant Phone: - _1 Applicant email: <br /> Property owner Name: <br /> Property owner Address: City: <br /> Ply Omer Rmw: Property Owner email: <br /> Well Total Depth(ft):1 I Acres to be Served by Wee: <br /> Use of Wei: ❑Domestic �nr'�1ior1 ❑Small Public water supply ❑ Municipal Public Water supply ❑Industrial ❑Stock <br /> ❑O# <br /> Depth of Corcoran Clay(ft): <br /> Proposed Weft Capacity(galift): W a Estimated Pumpng Rate(gallmin): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet) �(G <br /> Akded Cumulative Extraction Volume before January 1,2020(acre-feet) <br /> TIM <br /> �,w � k <br /> u-' ds x , <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 /> Wd#1 Information <br /> Use of Wei: ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑Munic4A 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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcchd.com <br />