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c t , <br /> T <br /> ` S Q N Q Q Q N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> —Application Number: PA-1900240 Application Type: Site Approval <br /> Pro ect Address: 11000 N WEST LANE STOCKTON,CA 95242 Project APN: 059-08-029,059-08-030,and 059-08-007 <br /> Applicant Name: Gill Women's Medical Center,LLC Title: <br /> Applicant Address: c/o Brett S.Jolley,Shore McKinley Conger&Jolley,LLP 3031 W.March Ln.Ste 230 City/Zip: Stockton,CA 95219 <br /> Applicant Phone: 209477-8171 Email: bjolley@smcslaw.com <br /> Property Owner Name: Jasbir S.Gill Family Limited Partnership(c/o Chaman Gill) <br /> Property Owner Address: PO Box 1450 City/Zip: Lodi,CA 95241 <br /> Property Owner Phone: 415.676.1710 Email: chamangill@gmail.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Septic <br /> Process Wastewater Discharge: Ponds: I On site wase water treatment Applicable WDR: <br /> Storm Drainage System: on-site retention <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day Gallons/Person/Da Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers: <br /> Type of Process/Irrigated Lands Total Gallons/Day <br /> Process Water Usage. Phase I - Labor&Delivery 4,600 <br /> Process Water Usage. PhaseHospital <br /> Irrigation Water Usage: <br /> Total Gallons Per Da <br /> PROPOSED WELL LOCATION <br /> Well Location Address: 11000 N WEST LANE STOCKTON,CA 95242 Cit : Stockton <br /> Well Location APN: Ub9-08-029 <br /> Well Latitude: 38°3'36.96"N Well Lon itude: 121.1T41.57W <br /> Flood Plain Designation: Well Elevation: 26 ft <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 TBD Acres to be Served by Well: 40 <br /> Use of Well: ❑ Domestic ❑ Irrigation ®Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): TBD <br /> Proposed Well Capacity (gal/ft): TBD Estimated Pumping Rate (gal/min): TBD <br /> —Anticipated Pumping Schedule (gal/day): TBD Estimated Annual Extraction Volume(acre-feet): TBD <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): TBD <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: 1,400 FT Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: 1,400 FT Stream/River: 120 FT <br /> Animal or Fowl Enclosured I Navigable Waterwa <br /> Storm Drainage System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: ❑Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s*cehd.com <br /> 1 of 2 <br />