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SAN-IOAQUIN <br />— COUNTY----- <br />' <br />Greatrtes, grow: icer;: <br />Environmental Health Department <br />Water Usage Information <br />PROJECT INFORMATION <br />PROPOSED WELL LOCATION <br />Application Number Application <br />Type: SITE APPROVAL <br />Pf0 ect Address: 865 E ROTH ROAD LATHROP CA 95231 Project APN: #193 -320 - <br />Applicant Name: <br />Title: <br />Applicant Address: <br />City/Zip: <br />Applicant Phone: <br />Email: <br />PROPOSED WELL INFORMATION <br />Well Total De th (ft):1 NIA <br />Property Owner Name: suKHCHAIN GILL <br />Use of Well: <br />Property Owner Address: 865 E ROTH ROAD LATHROP CA 95231 <br />City/Zip: <br />LATHROP/ CA 95231 <br />Property Owner Phone: (209)495-0653 <br />Email: <br />sam@sunrisetruckinginc.com <br />SERVICES INFORMATION <br />Estimated Annual Extraction Volume (acre-feet): <br />Please provide description below: <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />Water Supply: EX. ONSITE PRIVATE WELL ❑ Surface Water (Aftach Water Rights Information) <br />Domestic Wastewater Disposal: EX. ONSITE WASTEWATER TREATMENT SYSTEM <br />Process Wastewater Discharge: Pond I Applicable <br />WDR: I NIA <br />Storm Drainage System: EX. ONSITE DETENTION POND <br />Other Wells: <br />WATER USAGE DATA <br />Sewer Lines: <br />Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br />Domestic Water Usage by Employees/Customers: 12 <br />35 420 <br />Type of Process/Irrigated Lands Total Gallons/Da <br />Process Water Usage: NIL <br />Process Water Usage: NIL <br />Irrigation Water Usage: NIL <br />Source/Date of Reference: <br />Total Gallons Per Da <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />1 of 2 <br />PROPOSED WELL LOCATION <br />Well Location Address: NIA <br />1 Ci <br />Well Location APN: <br />Well Latitude: <br />WellLon itude: <br />Flood Plain Designation: <br />Well Elevation: <br />PROPOSED WELL INFORMATION <br />Well Total De th (ft):1 NIA <br />Acres to be Served b Well: <br />Use of Well: <br />❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />❑ Other: <br />Depth of Corcoran Clay <br />(ft): <br />Proposed Well Capacity <br />(gal/ft): <br />Estimated Pumping Rate al/min : <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />SITING INFORMATION <br />Distance To Nearest (ft): <br />Onsite: Offsite: Distance To Nearest (ft): Onsite: Offsite: <br />Wastewater Treatment System: EXISTING HENCE NIA Sources of Contamination: <br />Other Wells: <br />Pond/Lake: <br />Sewer Lines: <br />Stream/River: <br />Animal or Fowl Enclosure: <br />Navigable Waterway: <br />System: <br />Storm Drainage System:1 <br />I I Potential Recharge Features: <br />GROUNDWATER INFORMATION <br />Depth (ft): <br />Source/Date of Reference: <br />Groundwater Subbasin: <br />Current Depth to Water: <br />38 <br />SOILS BORING LOG DONE IN APRIL 2015 <br />❑ Cosumnes Subbasin (2-22.16) <br />❑ Eastern San Joaquin Subbasin (5-22.01) <br />❑ Tracy Subbasin (5-22.15) <br />Highest Depth to Water: <br />Lowest Depth to Water: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />1 of 2 <br />