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SAN JOAQUIN COUNTY PA2 10 °°93 Environmental Health Department Water Usage Information PROJECT INFORMATION Application Number: I Application Type: Project Address: '177 7" L.Q.2. t t ---1--N-4 S.-r *---1",2.c._‘_, Project APN: ..2.15C.) Applicant Name: - ...'i_ .-"p-o i>_,-rt,...- 2' _S , t_ ( ,---' Title: Applicant Address: .-t 1 77 bz_.:, 1 ?Thi ST City/Zip: 71-.)...JA.4.Ly , C .A q 536;9 Applicant Phone: L-( j S -7t, co — 1 GD--, Email:123.v.)L2..-N) Property Owner Name: Property Owner Address: City/Zip:I Property Owner Phone: Email: SERVICES INFORMATION Please provide description below: Water Supply: oP T E pt2opa,610 Surface Water (Attach Water Rights Information) Domestic Wastewater Disposal: F-)- if' 1-1 c_ --r-4-,,ti ,,e__ ' ' / Process Wastewater Discharge: Ponds: i Applicable WDR: Storm Drainage System: '-zes. i ----rt.D -T-1...IF.; (2,-&---c c,1,01.-- WATER USAGE DATA Provide for total water usage at full buildout Number Persons/Day Gallons/Person/Day Total Gallons/Day Domestic Water Usage by Employees/Customers: I , 6 Type of Process/Irrigated Lands Total Gallons/Day Process Water Usage: O -) Cr- Cr__ _S-1- N t-4 Process Water Usage: Irrigation Water Usage: k.. E-1-4.._ L-r,--4-\'‘-errt-- Total Gallons Per Day: 9 PROPOSED WELL LOCATION PO/Pc Well Location Address:I City: Well Location APN: Well Latitude: Well Longitude: Flood Plain Designation: Well Elevation: PROPOSED WELL INFORMATION Well Total Total Depth (ft): Acres to be Served by Well: Use of Well: 0 Domestic E Irrigation 0 Small Public Water Supply D Municipal Public Water Supply 0 Industrial 0 Stock CI Other: Depth of Corcoran Clay (ft): Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume (acre-feet): 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: 1 Groundwater Subbasin: Current Depth to Water: G 0 -4-/ _ 0 etc..., xopt. L Lo g%Lf..._ Co Y.D 'ITIZADC11 o1,1 LI Cosumnes Subbasin (2-22.16) CI Eastern San Joaquin Subbasin (5-22.01) 0 Tracy Subbasin (5-22.15) Highest Depth to Water: G b -47_ Lowest Depth to Water: 30 -v.- 1868 E. Hazelton Avenue I Stock on, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sicehd.com (LriAy 1 of 2