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09/25/2019 07:55 Canepa & Sons (FAX) <br /> P,006/0011 <br /> SAN J 0 AQ U I N Environmental Health Department <br /> --COUNTY— <br /> New <br /> -----COUN`T"YNew 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; `J �,!��; S �� City: ! <br /> Well Location APN: rq, _ -�kr;-- <br /> Well Latitude: 3-7°4S ' 3 3.��-�� 1.1 Well Longitude: Z I ° (0 ' 4. --D 3" W <br /> Flood Plain Designation: Well Elevation; i <br /> Applicant Name: Canepa and Sons,'lne. Applicant Title: Contractor <br /> Applicant Address: 14334 Cuesta Court City: Sonora <br /> Applicant Phone: (209)532-1136 Applicant email: csonsdrilling@_email.com <br /> Property Owner Name: 3ii y 49. ilAv Dl-,,-11V <br /> Property Owner Address: /-5-q/7 h-vZ City: ��/ �n•' <br /> Property Owner Phone: 2_ Property Owner email: <br /> —PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: ❑ Domestic Xirrigation ❑Small Public Water Supply O Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> 171 Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): J,1;00 J <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet):I �, <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 0 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): ' f To: From: <br /> Annual Extraction Volume(acre-feet: ' Estlmated ❑ Measured <br /> Specific Capacity(gal/min/ft); <br /> Other Pumping Tests Performed Test Result: <br /> R e c e i v e d T i m eo'e p, 2 5. ° 12 P 9" 7: 534"N 0' M P I T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />