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SAN J0A0UIN p <br /> ° Environmental Health Department <br /> —COUNTY <br /> `sc, r Greatness 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 <br /> known. The Environmental Health Department must collect this information before a new well <br /> permit is issued and must post the information on the Department's website for public information. <br /> Well Location Address: City: 6n (Q <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood plain Designation:, Well Elevation: <br /> Applicant Name: Applicant Title: <br /> Applicant Address: City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: I City: - <br /> Property Owner Phone: Property Owner email: <br /> Well Total Depth(tt): Acres to be Served by Well:1 Z-41 <br /> Use of Well: ❑Domestic lnigation ❑Small Public Water Supply O Municipal Public Water Supply ❑industrial ❑Stock <br /> Use of Well <br /> Other. __-- <br /> Depth of Corcoran Clay(ft): <br /> Proposed Wetf Capacity(gavft): Estimated Pumping Rate(gallmin): <br /> Anticipated Pumping Schedule(galiday): =-Estimated Annual Extraction Volume(acre-feet): O <br /> Estimated(UM1121tive L traction 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: <br /> ❑Domestic Arrigation ❑Small Public Water Supply ❑Municipal P ' ater Suppl ❑lndustn i ❑ Stock <br /> ❑Olher. <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom of Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annum Extraction Volume(acxe-feetEstimated D Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-342.0 1 F 209 464-0138 1 www.sjcehd.com <br />