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QUN <br />SAIGOAQUIN <br />/) COUNTY <br />\ diSL.,3r Greatness grows here. <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 Department's website for public information. <br />WELL LOCATION AND OWNER INFORMATION <br />Well Location Address: F 41SY A."-- e.....,erry-4..t. r„ , 0-0, frmh t City: rICa 1,1.4 e 0 <br />Well Location APN: 06-7 ...0 51- if 76, - d 06' <br />Well Latitude: Well Longitude: <br />Flood Plain Designation: 4 Well Elevation: <br />Applicant Name: TA - ' S kfc...11 v ri It 0 Applicant Title: <br />Applicant Address: fe Tok 9.1.5(Tri--#4,e6-14. City: Or:S.5011 ii5-7 Applicant Phone: s-3c, _ 9 -3-34ky z_s- Applicant email: • 6 kt i',5. 0 t juip ovw, 1 <br />, . . Property Owner Name: CA ryi I do Z. t ittn i-, ni i <br />Property Owner Address: 9:7 -Box 400 City: p A7carn 0 <br />Property Owner Phone: -2_4,7-4,7 4f— 6q o ( Property Owner email: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): 6o c Acres to be Served by Well: Fs,0 <br />Use of Well: 0 Domestic.--14 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply 0 Industrial 0 Stock <br />0 Other: <br />Depth of Corcoran Clay (ft): <br />Proposed Well Capacity (gal/ft): 5'01 6,--srin Estimated Pumping Rate (gal/min): 70 a <br />Anticipated Pumping Schedule (gal/day): ./VA Estimated Annual Extraction Volume (acre-feet): .4//,4 <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): "f../M <br />EXISTING WELLS INFORMATION <br />Total Number of Existing Wells on <br />Please complete the information below Please <br />Property: - <br />for every well on property. Use extra paper if needed <br />Well #1 Information /1/0 ;ii Fe3 <br />Use of Well: 0 Domestic 0 Irrigation 0 Small Public Water Supply CI Municipal Public Water Supply <br />0 Other: <br />CI Industrial 0 Stock <br />Total Depth (ft): <br />0 Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): To: From: <br />Pumping Rate (gpm): To: From: <br />Annual Extraction Volume (acre-feet: 0 Estimated 0 Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com