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QU),V <br /> SAN J O A Q U I N Environmental Health (Department <br /> ---- C O U I`.l T Y-- <br /> °wc, ' Grcotness 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: — City: Tc� <br /> Well Location APN: 15 � <br /> Well Latitude: 3- '7 // Well Longitude: —& , <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Applicant Title: � X— <br /> Applicant Address: cyn Rd City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: ( L City: <br /> Property Owner Phone: & Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: .L/9/ <br /> Use of Well: ❑ Domestic I Qrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 200 Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): 11W Estimated Annual Extraction Volume(acre-fee <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: d <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 />