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Environmental Health Department <br /> SAN 10AQUIN <br /> ----COUNTY <br /> �`c'�tdaoa� 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:1 (O 3 rv, Z., a-r r'1<<,4 le city: $%o <br /> Well Location APN: S <br /> Well Latitude: �K p a 55 3 a Well Longitude: !d I.y q 3 <br /> Flood Plain Designation: Well Elevation: I O <br /> Applicant Name: Cal Applicant Title: <br /> Applicant Address: 340,3 5 K; city: —TO' to - <br /> Applicant Phone: �t,7- ] -1, <br /> a Applicant email: (� Awa e <br /> Property Owner Name:1 C j (j a <br /> Property Owner Address:', 5 q S ! i z��� e ( C� r' 16 <br /> Property Owner Phone:! 1,� 5 — -S7 7 - O It b ( Property Owner email:1 SON. <br /> wQT <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: <br /> Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): I Estimated Pumping Rate(gal/min): I d <br /> Anticipated Pumping Schedule(gallday): 300 Estimated Annual Extraction Volume(acre-feet): I, S Q c,rer <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> Please complete the in <br /> below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: <br /> ❑Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> 0 Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): <br /> 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.sjcehd.com <br />