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rf♦1j� <br /> °{ S A N.-J 0 A Q U I N Environmental Health Department <br /> f ' COUNTY— <br /> `` crFuRi? Gr ea Ness grows 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 /> WELGLOCATION AAIQ QVINER INFORMATION ,. .. � <br /> Well Location Address: h/0 ye2l City: <br /> Well Location APN: 3-3100- /D <br /> Well Latitude: 3 9 _p It 4 7 Well Longitude: 1�p —57 _ J-9. S <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: t�OSS4 Jwe. Applicant Title: <br /> Applicant Address:_d3i 2V City: <br /> Applicant Phone: �9_ 32_//� Applicant email: <br /> Property Owner Name: �� ajj� /qo ee <br /> Property Owner Address: /300 1 '2 S. City: <br /> Property Owner Phone: Property Owner email: <br /> , - — _ _ C"•-,.. JSj�1'..' �yMT Y$i�e}r 4S4 Fdf 4 A', <br /> Well Total Depth(ft): /,a pp ' Acres to be Served by Well: <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(gal/ft); Estimated Pumping Rate(gallmin): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet):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 VStock <br /> YOther. ya..nd <br /> Total Depth(ft): / To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): (zP/+'J To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: 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 />