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SAN JOAQUIN Environmental Health Department COUN FY- -Water Usage Information PROJECT INFORMATION A plication Number: Application Ty e: Project Address: 9150 E Hwy 12 Project APN: 05-112-048 Applicant Name: Clift I enzi Title; Applicant Address; po box 343 City/Zip, victor ca 95253 Applicant Phone; 209-310-2252 Email: Cliff@lenzicon Com Prope r Owner Name: Clift t-enzi Prope Owner Address: po box 343 City/Zip: victor ca 95253 Property Owner Phone: 209-310-2252 Email; Cliff@lenzicon.com SERVICES INFORMATION Please provide descd tion below: water supply: San Joaquin County Water ❑ Surface Water(Attach Water Rights Information) Domestic Wastewater DispqsaL on site septic tank Process Wastewater Discharge: Ponds: Applicable WDR; Storm Drainage System: None on-site-purposing the use of Truegrid as a retention system for project proposal WATER USAGE DATA Provide for total water usage of full buildout Number Persons/Da Gallons/Person/Day Total Gallons/Day Domestic Water Usage by Employee s/C usto mers: 12/day 15 gal/personlday 60 gallday Type of Process/Irrigated Lands Total Gallons/Da Process Water Usa e: none 0 Process Water Usa e: Irrigation Water Usage: Total Gallons Per Day: 60 gallday PROPOSED WELL LOCATION Well Location Address: I Cit Well Location APN; Well Latitude: Well Longitude: Flood Plain Desi nation: Well Elevation: PROPOSED WELL INFORMATION Well Total De th ft): Acres to be Served b Well: Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock ❑ Other: Depth of Corcoran Clay eft; Proposed Well Capacity(9aI ft); Estimated Pumpin Rate( altmin Anticipated Pumping Schedule allda : Estimated Annual Extraction Volume acre-feet Estimated Cumulative Extraction Volume before Januwy 1,2020(acre-feet):l SITING INFORMATION Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: Wastewater Treatment System: 20 feet none Sources of Contamination: none none Other Wells; none none Pond/Lake: none none Sewer Lines: none none Stream/River: none 1 mile Animal or Fowl Enclosure: none none Navigable Waterway: none none Storm Drainage System: none none Potential Recharge Features: none none GROUNDWATER INFORMATION Depth ft): Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: ❑ Cosumnes Subbasin(2-22,16) Highest Depth to Water: ❑ Eastern San Joaquin Subbasin(5-22.01) Lowest Depth to Water; C 1 Tracy Subbasin(5-22.15) 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 1 www.s*cehd.com 1 of 2