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SAN J 0 A Q U I N Environmental Health Department <br /> OUNTY <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: P6) ® Floe) /Zq/ City: �IrndPn <br /> Well Location APN: 705 I O 3 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: ;Pj4.,jchr-q Applicant Title: 6jncr <br /> Applicant Address: / &75 City: <br /> Applicant Phone: ;&q- 4p&2-/44z./ Applicant email: o� A44L fl� trrnJ <br /> Property Owner Name: 6 <br /> Property Owner Address: a00City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): S D o Acres to be Served by Well: d <br /> Use of Well: ❑ Domestic ® Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): Xjc>N <br /> Proposed Well Capacity(gal/ft): 619 Estimated Pumping Rate(gal/min): $`O <br /> Anticipated Pumping Schedule(gal/day): Z 3 omo Estimated Annual Extraction Volume(acre-feet): 60 <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <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: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): 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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />