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SKJOAQUIN <br />— <br />COUNTY— <br />Environmental Health Department <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 Departments website for public information. <br />WELLLE ATK�A404WWR INFORMAMON <br />. . <br />wed Location Address: S <br />F <br />Well Location APN: 2 (o - O <br />❑ Small Pubic Water Supply ❑ Municipal Pudic Water Supply ;KlndustrW ❑ Stock <br />Well Latitude: 7• <br />Wei L.on;,,brde. 1 /. `3a! f <br />Flood Plain Designation: <br />Wed Elevation: 5 <br />Anticipated Pumping Schedule (gaUday): <br />Estimated Annual Extraction Volume (acre-feet): a <br />Applicant Name: w <br />Applicant Title: <br />Applicant Address: 37100 5 9,xv <br />City <br />Applcant Phone: Zp - 2 31- - 36 <br />APpIkant em til: <br />Annual Extraction Volume (Scro-faet /60 <br />Property Owner Name: c ��' rc <br />60() <br />Property Owner Address: 37 CO S GCj <br />City c, <br />Property Owner Phone: 2C>9_,2 344 -'35 <br />ROpef ty Owner ernes:� o .. n <br />PRQPOSED 9}QMA JQR <br />. . <br />Wei Total Depth (ft):1 1 106& Acres to be Served by W811: <br />Use of Well: <br />❑ Domestic ❑ Irrigation <br />❑ Other. <br />❑ Small Pubic Water Supply ❑ Municipal Pudic Water Supply ;KlndustrW ❑ Stock <br />Depth of Corcoran Gay (ft): <br />Proporied Wel Capacity (gaM) <br />EstiTabd Pm*g Rate (geWTMn): G <br />Anticipated Pumping Schedule (gaUday): <br />Estimated Annual Extraction Volume (acre-feet): a <br />Total Depth (ft): 6416 <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet). <br />EXISTING WBO 1.VFWUTN* <br />L <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 Wei: <br />�131)omeak O Irrigation <br />❑ Other. <br />❑ al SmPubic Water Supply ❑ Municipal Public Water Supply <br />❑ Industrial ❑ Stock <br />Total Depth (ft): 6416 <br />To: 560 <br />El Open Bottom or Screen Interval (ft) To: 5 <br />To: EgC> <br />From: <br />From: <br />From: $60 <br />Casing Diameter (i) 6 <br />Pumping Rats (Wn): <br />Annual Extraction Volume (Scro-faet /60 <br />O Estimated ❑ Measured (11,16) <br />60() <br />Specific Capacity (gaumm): /, <br />Other Pumping Tests Performed: <br />Tea Raw <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.ocohd.com <br />7c.m},-, <br />12C. a,wY, <br />