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SAN J O A O U I N 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:) 2 1 Cityl- fICAIDN <br /> Well Location APN: - <br /> Well Latitude: 7.'7 ¢j Well Longitude: _ 5� <br /> Flood Plain Designation: Well Elevation: r <br /> I <br /> Applicant Name: S - DA S ApplicantTitfe: <br /> Applicant Address: C City: <br /> Applicant Phone. to 9 - 1a Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: -— _ -- City:, <br /> Property Owner Phone: Property Owner email:i <br /> i PROPOSED WELL INFORMATION <br /> !----Well Total Depth(ft):I I liAcres to be Served by Well: 0 <br /> Use of Well: <br /> ❑Domestic Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gait) �__ Estimated Pumping Rate(galimin): <br /> Anticipated Pumping Schedule(gal/day):t I Estimated Annual Extraction Volume(acre-feet). <br /> Estimated Cumulative Extraction Volume before January 1.2020(acre-feet): <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 WWell:! omestic LiIrrigation ❑Small Public Water Supply `, Municipal Public Water Supply a Industrial ❑Stock <br /> ❑Other <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in)- kDt ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 2Z, To: I From: <br /> Annual Extraction Volume(acre-feethZ , )Estimated ❑ Measuredl <br /> Specific Capacity(gallminlft}a - <br /> Othar Pumping Tests Performed:1 Test Result: <br /> 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />