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SKJOAQUIN <br /> Environmental Health Department <br /> i <br /> �"';�, ,•�3 COUNT Y <br /> Grectness orows 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 Address: 73DS Al JvApeAe (-y I City: ZJHbiN A#, f V.5 —fi/, <br /> Well Location APN: <br /> Well Latitude: 3 8 _p _�/,f�( Well Longitude: /moo — E- 7 <br /> Flood Plain Designation: Well Elevation: a 73 <br /> Applicant Name: Norspivs SNC• Applicant Title: <br /> Applicant Address: /,,,q3,gjj e vcsT A CT City: 5p"PA 4 gl^3 70 <br /> Applicant Phone �1,p f r:5 2_ /3,�, Applicant email: c s o vs ojei«jN jC <br /> Property Owner Name: /�ggp�,o l>Ei2f��AiivE / �T <br /> Property Owner Address: i city:Fj¢,P�y�iNPPDN <br /> Property Owner Phone: Property Owner email: <br /> i - <br /> r Well Total Depth(ft): � ` Acres to be Served by Well: " p <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑Industrial Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity Estimated Pumping Rate(gal/min): =�j- <br /> Anticipated Pumping Schedule(gal/day): �iD c%v-- Estimated Annual Extraction Volume(acre-feet): / <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <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 ,Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): 46 r` ❑ 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): la) <br /> Other Pumping Tests Performed: II&A& 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 />