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SAN JOAQUIN Environmental Health Department <br /> 0:1j TY <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 II ,����, <br /> Well Location Address: 2A-146 -I104 14am-e City' 1.�.i�.� <br /> Well Location APN: ovi- C)L4 O O <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: L Applicant Title: _ W <br /> Applicant Address: PO "! City: Li rNztf�o <br /> Applicant Phone: _ 9 8 8, S 4xG Jr Applicant email-, Krryl Q WeS41nc,. Yn <br /> Property Owner Name:",�,eaA Gpekl.1' C OQhr►in + t1 l,l.(r <br /> Property Owner Address: P.O. -161 city.T L <br /> Property Owner Phone: _ 989- 646S Property Owner email: kL m�a W ;rr_, <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):; Acres to be Served by Well: o1q Q Pt C_ <br /> Use of Well- 0 Domestic w6gation ❑SmallPublic Water Supply ❑ Municipal Public Water Supply ElIndustrial O Stock <br /> ❑Other: <br /> ---------- ---- <br /> Depth of Corcoran Clay(ft): 11\1c>lVe <br /> Proposed Well Capacity(gal/ft): 50 Estimated Pumping Rate(gatlmin): ['a p O <br /> Anticipated Pumping Schedule(gal/day): 2 0 g 00 Estimated Annual Extraction Volume(acre-feet): p <br /> - - -- -— -Y-- - <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): Q <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 9 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/minlft): <br /> Other Pumping Tests Periormetl: • - 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 />