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SANAAQUINp <br /> Environmental Health Department <br /> c ` COUNTY— <br /> r l °•` 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 /> 1 J.S%:- <br /> Well Location Address: K <br /> Well Location APN: 210 <br /> Well Latitude: Well Longitude: —In V12 910(W <br /> Flood Plain Designation: Well Elevation: Zr <br /> Applicant Name: _ Applicant Title: K <br /> Applicant Address: City Cj;3o v <br /> Applicant Phone: — Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City. <br /> Property Owner Phone: Property Owner email: <br /> 112, - <br /> IT <br /> Wel Total Depth(ft): Apes to be Served by Wel] .� <br /> Use of Well: ❑Domestic Al�`rrigation 1-1SmallPublic Water Supply [I Municipal Public water Supply 171 Industrial El Stock <br /> L1 Other <br /> +f <br /> Depth of Corcoran Clay(ft): +� <br /> Proposed Well Capacity(gaM): Estimated Pumping Rate(gailmin): <br /> Anticipated Pumping Schedule(gal/day): ,00UU Estimated Annual Extraction Volume(acre feet) <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> Total Number of Existing Wells on Property �U �^ <br /> pp� <br /> Please complete the information below for every well on property.Use extra paper if needed ✓ V <br /> Well#1 Infonnatkm <br /> Use of Well: ❑Domestic ❑Irrigation ❑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 11 Measured <br /> Specific Capacity(gallmintit): _ <br /> Other Pumping Tests Performed: Test Result <br /> 1868 E. Hazelton Avenue I Stockton,Califomia 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />