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° A N ` <br /> S�� �QAQ Q I N 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 AND OWNER INFORMATION <br /> Well Location Address: 8 L 4 �— y City: p <br /> Well Location APN: 0'5- ///C)6 6 <br /> Well Latitude: SSa v Well Longitude: -- I;L- <br /> Flood Plain Designation: Well Elevation:179 <br /> Applicant Name: ,- ' Applicant Title: <br /> Applicant Address: a o 7 City. <br /> Applicant Phone: _9/yo Applicant email: --- <br /> Property Owner Name: Q/ c_ <br /> Property Owner Address: S'� City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): _1062 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Rfrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): IVN <br /> Proposed Well Capacity(gal/ft): �;L_Dv rn Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1, 2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> '7d�__� <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 /> ❑ Domestic rrigation ❑ Small Public Water Supply ❑ Municipal 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />