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SAN J Environmental Health Department <br /> ------ COUNT Y <br /> Greatness grows hero . <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number : Application Type : _ <br /> Project Address : �;, _to <br /> Pro ' ect APN : <br /> Applicant Name : Title : <br /> 15 MINIP . 111I <br /> Applicant Address : , - City/Zip : ' �, . <br /> eL <br /> Applicant Phone : 9tioalEmail : ,� 0 <br /> Property Owner Name : w <br /> IFF k <br /> Property Owner Address : �� ,� � City/Zip : a :. i <br /> M <br /> Property Owner Phone : Email : ' ✓ sS1 <br /> SERVICES INFORMATION <br /> Please provide description below : <br /> Water Supply : Pr i � �j,- (r ❑ Surface Water (Attach Water Rights Information ) <br /> Domestic Wastewater Disposal : <br /> Process Wastewater Discharge : Ponds : Applicable WDR . <br /> Storm Drainage System : <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/ Day Gallons/Person / Day Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers : ? z <br /> Type of Process/ Irrigated Lands Total Gallons/Day <br /> Process Water Usage . - <br /> Process Water Usage : <br /> 011, <br /> Irrigation Water Usage : 41 SCO V t' C� <br /> Total Gallons Per Day : (� <br /> PROPOSED WELL LOCATION <br /> Well Location Address : VOLVIltiA q e Ci <br /> Well Location APN : _ <br /> Well Latitude : �f ' Well Longitude : I � <br /> Flood Plain Designation : Well Elevation : <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth RL I Acres to be Served by Well : <br /> Use of Well : <br /> ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> Q' Other: Pcr V A L. L <br /> Depth of Corcoran Clay (ft) : : <br /> Proposed Well Capacity (gal/ft) : Estimated Pumping Rate (gal /min ) : <br /> Anticipated Pumping Schedule (gal /day) : u 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) : Onsite : Offsite : Distance To Nearest (ft) : Onsite : Offsite : <br /> Wastewater Treatment System : L/ 42 Sources of Contamination : <br /> Other Wells : r 12 Pond/Lake : <br /> Sewer Lines : 14,e Stream/River: <br /> Animal or Fowl Enclosure : /1% ,C Navigable Waterway : U <br /> Storm Drainage System : L6 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 : i ❑ Tracy Subbasin ( 5-22 . 15) <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 www . sicehd . com <br /> 1 of 2 <br />