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SAN 10AQUIN 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:) �p tc, C4:1 L,Ncl r, <br /> Well Location APN: O ell p <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: N,_ Well Elevation: <br /> Applicant Name:. Jv(�,�,- �;�S N' S .�h,,,s, Applicant Title: 0 uT <br /> Applicant Address: � A City: <br /> Applicant Phone: ,2 ci- /_ Applicant email: <br /> Property Owner Name:111 _AAAT_ Q e_ �.� < �c�v ��-M <br /> Property OwnerAddress: O 91A City] C-A <br /> Property Owner Phone: ;.?-c:5- Ss 8 7-7 6S' Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): o + Acres to be Served by Weil: 8u £ <br /> Use of Well: ❑Domestic JWrrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑ Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft):1 1,4 C ji.4 <br /> Proposed Well Capacity(gallft)il 10Svvojrj Estimated Pumping Rate(gal/min): yv 0 <br /> Anticipated Pumping Schedule(gal/day): < k � I Estimated Annual Extraction Volume(acre-feet): 9810 <br /> Estimated Cumulative Extraction Volume before January 1,30.2-0(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: AKDomestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): 3 t�)%:; - To: 4,,r_,,,,,.,ti 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: 15 Estimated ❑ Measured <br /> Specific Capacity(gallmin/ft): <br /> Other Pumping Tests Performed: k C���v 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 />