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SANDJOAQUIN Environmental Health Department <br /> COUNTY <br /> cy�, P Greatness grows he <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: a I a� S; �� 2 City: (>1 <br /> Well Location APN: 1-7 o j <br /> Well Latitude: -37 ,6 o Well Longitude: — I D I. <br /> Flood Plain Designation: Well Elevation: �Qo <br /> Applicant Name: 'r Applicant Title: <br /> a <br /> Applicant Address: -3 pa S �',1ro City: t v <br /> Applicant Phone: _-�ci 3� Applicant email: a� �� r1 Y)b Po Cr A t o rr. <br /> Property Owner Name: c>o� <br /> Property Owner Address: a`ldt,,_e_,� S,1 ' Ci <br /> Property Owner Phone: y p c\ Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I 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): I , S Estimated Pumping Rate(gal/min): lap <br /> Anticipated Pumping Schedule(gal/day): 5Estimated Annual Extraction Volume(acre-feet): a,p <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 Well: omestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): I to To: From: <br /> Casing Diameter(in): g ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: .-e) ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />