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SAN J 0 A Q U I N Environmental Health Department <br /> — -COUNTY-- <br /> Greotness 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: ALLt2Fe AO& I City: C-�, 9?530 <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: A IAhh( L4jj �A Applicant Title: zI 1,)Akz <br /> Applicant Address: X58 CpkInD/IJr /ZU e City: <br /> Applicant Phone: o /176,4 Applicant email:�//a�,.�hf�✓�t rG✓ G� rn ./1.,w <br /> Property Owner Name: ASaA vd-A <br /> Property Owner Address: .156U 1/ 41,0rZ P.VtCity: - C <br /> Property Owner Phone: M Property Owner email: i9 <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft): gill') Acres to be Served by Well: <br /> Use of Well: ❑ Domestic -4irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 5700` 700 Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): -7a,l 00c> I Estimated Annual Extraction Volume(acre-feet): /�00 <br /> Estimated Cumulative Extraction Volume before January 1, 2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: J <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): lqp To: /',A From: <br /> Casing Diameter(in): 6' ❑ Open Bottom or Screen Interval(ft): To:AIA From: <br /> Pumping Rate(gpm): To:/1-44- From: <br /> Annual Extraction Volume(acre-feet: /V69 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): s <br /> Other Pumping Tests Performed:I IVA Test Result: A <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />