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SAN 10 A Q U I N Environmentai Health Department --- COUNTY Water Usage Information PROJECT INFORMATION Application Number: PA-2z00036 Application Type: SITE APPROVAL Project Address: 11100&11140 S.MANTHEY ROAD Project APN: 193-33D-22&-16 Applicant Name: INDERJITDEHAL Title: MR. Applicant Address: 24o4 LOTUS WAY City/Zip: TRACY/95376 Applicant Phone: 4o"96-mos Email: INDERJIT@IDEHAL.COM Property Owner Name: INDERJIT DEHAL Property Owner Address: 24o4 LOTus WAY City/Zip: TRACY/95376 Property Owner Phone: 4o"96-o4o6 Email: INDERJIT®IDEHALCOM SERVICES INFORMATION Please provide description below: NO ONSITE WATER SERVICES ARE PLANNED Water Supply: N/A ❑ Surface Water(Attach Water Rights Information) Domestic Wastewater Disposal: N/A Process Wastewater Discharge, Ponds: wA F Applicable WDR: I N/A Storm Drainage System: ONSITE RETENTION POND WATER USAGE DATA Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da Domestic Water Usage by Employees/Customers: 0 10 0 Type of Process/Irrigated Lands Total Gallons/Da Process Water Usage: wA o Process Water Usage: 111wA o Irrigation Water Usage: I N/A o Total Gallons Per Day: o PROPOSED WELL LOCATION Well Location Address: NO WELL PROPOSED CI : N/A Well Location APN: wA Well Latitude: N/A Well Longitude. Flood Plain Designation: N/A Well Elevation: N/A PROPOSED WELL INFORMATION Well Total Depth(ftfl N/A Acres to be Served by We11:j N/A Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock ❑Other: Depth of Corcoran Clay(ft): N/A Proposed Well Capacity (gal/ft): wA Estimated Pumping Rate (gal/min): N/A Anticipated Pumping Schedule altda : wA Estimated Annual Extraction Volume(acre-feet): wA Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): N/A SITING INFORMATION Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: Wastewater Treatment System: wA N/A Sources of Contamination: N/A N/A Other Wells: wA N/A Pond/Lake: N/A wA Sewer Lines: N/A wA Stream/River: WA wA Animal or Fowl Enclosure: wA wA Navigable Waterwa ' wA N/A Storm Drainage System]4 N/A Potential Recharge Features: wA wA GROUNDWATER INFORMATION Depth(ft): Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: 0.22 DWR Well 378562N1212685W001 (10/24/17) ❑Cosumnes Subbasin(2-22.16) Highest Depth to Water: 11.52 DWR Well 378562N1212685W001 (04/15/83) a Eastern San Joaquin Subbasin(5-22.01) Lowest Depth to Water: _16.08 DWR Well 378562N1212685W001 (10/07/77) ❑Tracy Subbasin(5-22.15) 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-34201 F 209 464-0138 1 www sicehd.com 1 of 2