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. ✓'�c o`"-nor`S ("�:-"r l o t- 3 ��.k# ��q- y 6 �-U 13�' <br /> SAN 10A 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 /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: c{pl L, o City: L,�✓c�t„ <br /> Well Location APN: d y! c <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: N,_ ' Well Elevation: <br /> Applicant Name:. J+��,�,-�,,c: s N� S h,N Applicant Title: 0 W-f <br /> Applicant Address: a L9 f ,� City: <br /> Applicant Phone: o,c, Applicant email: <br /> Property Owner Name: _ AA)lT ,Q « c-.- c ,civ.: �c <br /> Property Owner Address: City: [ ;,,, KN CA c14- <br /> Property <br /> 1 Property Owner Phone: 9_ `5 -796S'- Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 io '- Acres to be Served by Well: FL) £ <br /> Use of Well: ❑Domestic &rrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): Iv cN <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): yv%3 <br /> Anticipated Pumping Schedule(gal/day): t 1 Estimated Annual Extraction Volume(acre-feet): 98-0 - <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 3 <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: "Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): '3 To: 4 {��,. n: 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: k ��.�v t Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />