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a ' QUIN S Q N OAQUIN Environmental Health Department Q 1 . I kd Tk'� 1.::; : � ; COUNTY q0Q��" ` Greotness grows here . Water Jsage Information PROJECT INFORMATION Application Number : Application Type : Land Use Project Address : 4946 E Eight Mile Road Project APN : 086-070-09 Applicant Name : Waterloo Morada Fire District Title : Fire Chief Applicant Address : 6925 E Foppiano Lane City/Zip : Stockton , 95212 Applicant Phone : (209) 931 - 3107 Emaild shenry@sjgov . org Property Owner Name : Steven Chum Gong , Stewart Gong , Benny Gong , Way Jane Wong as Tenants in Common Property Owner Address : 4084 Chiavari Way City/Zip : Manteca 95337 Property Owner Phone : 916-813-5285 Email : None SERVICES INFORMATION Please provide description below : Water Supply : Private Well ❑ Surface Water (Attach Water Rights Information) Domestic Wastewater Disposal : Septic system Process Wastewater Discharge : Ponds : None A licable WDR : INone Storm Drainage System : Natural WATER USAGE DATA Provide for total water usage at full buildout Number Persons/ Da Gallon s/ Person/ Day Total Gallons/ Da Domestic Water Usage by Employees/Customers : 3 80 240 Type of Process/ Irrigated Lands Total Gallons/ Da Process Water Usage : None Process Water Usage : None Irrigation Water Usage : None Total Gallons Per Day : PROPOSED WELL LOCATION Well Location Address : 4946 E Eight Mile Road I Cit Stockton Well Location APN : 086-070-09 Well Latitude : 380 3124 . 82" N Well Longitude : - 121 ° 15' 15 . 05"W Flood Plain Designation : zone x Well EleVation : 1 43 ft PROPOSED WELL INFORMATION Well Total Depth (ft) : l Acres to be Served by Well ] Use of Well : ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock ❑ Other : Depth of Corcoran Cla ft Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume ( acre -feet) : o Estimated Cumulative Extraction Volume before January 1 , 2020 (acre-feet): SITING INFORMATION Distance To Nearest ft) : Onsite : Offsite : Distance To Nearest (ft) : Onsite : Offsite : Wastewater Treatment System : Sources of Contamination : Other Wells : Pond/ Lake : Sewer Lines : Stream / River: Animal or Fowl Enclosure : Navigable Waterway : Storm Drainage System : Potential Recharge Features : GROUNDWATER INFORMATION Depth (ft ) : Source/ Date of Reference : Groundwater Subbasin : Current Depth to Water : 75 Well/ Pump Permit 9/ 30/2003 ❑ Cosumnes Subbasin ( 2-22 . 16) Highest Depth to Water : ❑ Eastern San Joaquin Subbasin ( 5 -22 . 01 ) Lowest Depth to Water : ❑ Tracy Subbasin ( 5 -22 . 15) 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468 - 3420 1 F 209 464 - 0138 1 www . sicehd . com 1 of 2