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SAN 10 A Q U I N Environmental Health Department <br /> COUNTY - <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 AND OWNER INFORMATION <br /> Well Location Address: City: i y <br /> Well Location APN: <br /> Well Latitude: " j Well Longitude: * Z W <br /> Flood Plain Designation: Well Elevation: �2(� <br /> Applicant Name: p AApplicant Title: <br /> Applicant Address: ak Cd City: t5toL.{m <br /> Applicant Phone: of . q15 t . Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: Sfym City: <br /> Property Owner Phone: z 'J0—3 90 •410 0 1 Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I Acres to be Served by Well: j <br /> Use of Well: ❑Domestic VIrrigation ❑Small Public Water Supply D Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gallft): Estimated Pumping Rate(gailmin): �T <br /> Anticipated Pumping Schedule(gal/day): j S D o O Estimated Annual Extraction Volume(acre-feet): I): <br /> Estimate umulative Extraction Volume before January 1,2020(acre-feet): <br /> ­nr `v1 <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 if needed <br /> Well#1 Information <br /> Use of Well: J§Domestic ❑Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): t5-0 To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft); To: From: <br /> Pumping Rate(gpm): T. To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity(galtminlft): <br /> Other Pumping Tests Performed: A/o � tpi L.t( o- u (e( est 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 />