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,nom, S A N sJ O A Q U I N Environmental Health Department <br /> i� r 'I —COUNT`/--- <br /> P Greatness arotis5 herd <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 AND OWNER INFORMATION w. <br /> Well Location Address: -,&10-3 S A %k� City./1/lan <br /> Well Location APN: -Z Z b- 1 qo <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: yelg ^ Applicant Title: 0 L <br /> Applicant Address: o f-4 city: -Applicant <br /> tq <br /> Applicant Phone: Z Cj Applicant email- <br /> Property Owner Name: <br /> Property Owner Address: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL.INFORMATION <br /> Well Total Depth(ft): I '350 Acres to be Served by Well: -Z4. I.Z d <br /> Use of Well: ElDomestic Y Irrigation C3 Small Public Water Supply ❑Municipal Public Water Supply El Industrial EJ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal]ft): q,00 (, �^ Estimated Pumping Rate(gall/min): oo 6 v^ <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): ham,. 7 w+ <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): 1 <br /> EXISTING WELLSJNFORMATION <br /> Total Number of Existing Wells on Property: I <br /> Please complete the information below for every well on property.Use extra paif needed <br /> LL <br /> Well#1 Information <br /> Use of Well: ❑Domestic Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): -L-L C, To: From: <br /> Casing Diameter(in): 12 i r ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): LjCu 6 1 eo— To: From: <br /> Annual Extraction Volume(acre-feet: ` E timated ❑ 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 />