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S A N J O A Q U I N Environmental Health Department <br /> Ul —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 MORMATIO <br /> Well Location Address: 743 E. Critchett Ave City: Tracy <br /> Well Location APN: 241-110-36 <br /> Well Latitude: 'I-?.7 1111 1kWell Longitude: <br /> Flood Plain Designation: AE Well Elevation: <br /> Applicant Name: Calwater Drilling Co., Inc Applicant Title: ��- <br /> Applicant Address: 300 S. Kilroy Rd City: Turlock <br /> Applicant Phone: (209)667-7932 Applicant email: QJ�,���,�r- I cl`]6,9 Cr n C 1)1,co,-\ <br /> Property Owner Name: Tami Tavake <br /> Property Owner Address: 743 E. Critchett Ave City: Tracy <br /> Property Owner Phone: a o 31k Property Owner email: �'�,�.-{-a lahao �oY✓` <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I S O o Acres to be Served by Well: <br /> Use of Well: 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): Estimated Pumping Rate(gal/min): a a <br /> FAnticipated Pumping Schedule(gal/day): aoo Estimated Annual Extraction Volume(acre-feet): a. <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION r <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: IR/Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): t6 O 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.sjcehd.com <br />