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SAN:J 0 A Q U I N Environmental Health Department <br /> —COUNTY— <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 /> WELLQ�Ai'10119OIINE iNFQRMATION <br /> Well Location Address: ?�? s I City: Y <br /> Well Location APN: z(o p gp r /J _ <br /> We!(Latitude: 7 Well Lon;,,ud .- /a <br /> Flood Plain Designation: Well Elevation: 5 <br /> Applicant Name: w Applicant Title: <br /> Applicant Address: 37100 S. � C* <br /> Applicant Phone: 2,6 _ 2 3,L/ _ Applicant email: <br /> Property Owner Name: c�� <br /> Property Owner Address: 37 s CN. � c\ <br /> Property Owner Phone: zc> _,2S44 –35gi I Property Owner <br /> P PQ D fJfAl L'*FM <br /> Well Total Depth(ft):j 1 106& Acres to be Served by Well: <br /> Use of Well: ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply Aindustrial ❑Stock <br /> ❑Other. <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(galfft): 62, 7S I Estimated Pumping Rate(gal/min): 7Q <br /> Antidpated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): a <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> 9TI1 OVEM IMFOW <br /> Total Number of Existing Web on Property: <br /> Please complete the information below for every wagon property.Use extra paper if needed <br /> Well#1 Information <br /> Use of WeU:; <br /> ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft); To: 5 b p From: y <br /> Casing Diameter(n): 16 ❑Open Bottom or Screen Interval(ft): To: j From: 0 <br /> Pumping Rate(gpm): 2 To: 5 C From: 560 <br /> Annual Extraction Volume(acre-feet /60 ❑ Estimated ❑ Measured yU 60 <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed:1 Test Resuft: <br /> 1868 E.Hazelton Avenue I Stockton, Califomis 952051 T 209 468-4201 F 209 464-0138 1 www.sjoehd.com <br />