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SAN 1OAQUIN Environmental Health Department —COUNTY--- Gren,nrt Water Usage Information PROJECT INFORMATION Application Number: PA-2200142 Application Type: STAFFAPPROVAL Project Address: 6125 W Banner Street,Lodi,CA 95242 Project APN: 055-320-66 Applicant Name: David Burkett,AIA Title: Principal Architect Applicant Address: 1217 J Street City/Zip: Modesto,CA 95354 Applicant Phone: (209)522-8900 1 Email:I jaipatel56@yahoo.com Property Owner Name: PDK Hospitality LLC Property Owner Address: 1707 w Fremont Street City/Zip: Stockton 95203 Property Owner Phone: (209)483-6719 Email: david@redincarchitects.com SERVICES INFORMATION Please provide description below: Water Supply: County Service Area 31 ❑ Surface Water(Attach Water Rights Information) Domestic Wastewater Disposal: County Service Area 31 Process Wastewater Discharge: I Ponds: I I Applicable WDR: Storm Drainage System: 1 County Service Area 31 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: 4 Employees+130 avg guests 50 6,700 estimate Type of Process/Irrigated Lands Total Gallons/Da Process Water Usage: N/A Process Water Usage: N/A Irrigation Water Usage: N/A Total Gallons Per Day: 6,70o estimate PROPOSED WELL LOCATION Well Location Address: N/A City: Well Location APN: Well Latitude: Well Lon itude: Flood Plain Designation: Well Elevation: PROPOSED WELL INFORMATION Well Total Depth ft: Acres to be Served by Well: Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock ❑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: N/A Adjacent Street Sources of Contamination: N/A N/A Other Wells: N/A N/A Pond/Lake: N/A N/A Sewer Lines: N/A Adjacent Street Stream/River: N/A N/A Animal or Fowl Enclosure: N/A N/A Navigable Waterwa : N/A N/A Storm Drainage S stem: N/A Adjacent Street Potential Recharge Features: N/A N/A 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: ❑Tracy Subbasin(5-22.15) 1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 ( F 209 464-0138 1 www.s*cehd.com 1 of 2