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SAN JOAQUII, COUNTY --- Greatness grows here Environment;. .health Department Water Usage Information 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 of 2 www.secehd.com PROJECT INFORMATION Well Location Address: Application Number: Application Type: Project Address: T.B.D Well Latitude: Project APN: 003-100-330 Applicant Name: Evan teff Flood Plain Designation: Title: Applicant Address: 1518 K St. City/Zip: Modesto 95354 Applicant Phone: 209 248 7633 Acres to be Served by Well: Email: evan.zeff@gmail.mm Domestic ❑ Irrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): Property Owner Name: Bart Reobertson Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): Property Owner Address: 25000 Sequa Lane Estimated Annual Extraction Volume (acre-feet): City/Zip: Acampo 95220 Property Owner Phone: 209 329 9446 Email: bartParpmcompany.comil.com Distance To Nearest (ft): Onsite: Offsite: Distance To Nearest (ft): Onsite: Offsite: SERVICES INFORMATION Sources of Contamination: Please provide description below: Pond/Lake: Sewer Lines: Water Supply: Animal or Fowl Enclosure:1 ❑ Surface Water (Attach Water Rights Information) Domestic Wastewater Disposal: Potential Recharge Features: Process Wastewater Discharge: Ponds: licable WDR: Storm Drainage System: Groundwater Subbasin: Current Depth to Water: 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: Lowest Depth to Water: Type of Process/Irrigated Lands Total Gallons/Da Process Water Usage: Process Water Usage: Irrigation Water Usage: ornamental landscape 95 Total Gallons Per Day: 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 of 2 www.secehd.com PROPOSED WELL LOCATION Well Location Address: I Ci "k P a Well Location APN: 06 — 1 @0 - 3 3 O Well Latitude: Well Lon itude: Flood Plain Designation: Well Elevation: 29. PROPOSED WELL INFORMATION Well Total Det ft): Acres to be Served by Well: Use of Well: Domestic ❑ Irrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock 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:1 Navigable Waterwa Storm Drainage System] Potential Recharge Features: GROUNDWATER INFORMATION Depth (ft): I Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: ❑ Cosumnes Subbasin (2-22.16) ❑ Eastern San Joaquin Subbasin (5-22.01) ❑ Tracy Subbasin (5-22.15) Highest Depth to Water: Lowest Depth to Water: 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 of 2 www.secehd.com