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'`"1°"' SAN�JOAQUIN Environmental Health Department <br /> Water Usage Information <br /> P OJECT INFORMATION <br /> A Iicetion Number: A Iication T e: Sit A r 1 <br /> Pro'ect Address: 23335 D dds RD Escolon Ca 9532 Pro'ect APN: 2 7- 160-004-0000 <br /> A Iicant Name:DOS Di Sta LC Title:poi DI a5t <br /> A Iicant Address:1588 NBatavia St. Ste 1C Cit /zi :Oran a 92867 <br /> A Iicant Phone:$00-85 - Email:iSanCh0 <br /> Pm art Owner Name:ppS pi S r <br /> Pro art Owner Address:15 N B tavia St. Sta 1 C CI[ /Zi :Oran / 2867 <br /> Pro art owner Phones:g00-859-6163 Email:isanchez renewableo <br /> SERVICES INFORMATION' <br /> Please rovide descri tion below: <br /> Water Supply: We11S O Surtace Water(A(fach Wafer Rfghfs/nformafion) <br /> Domestic Wastewater Dis osai: SB tiC <br /> Process Wastewater Dische e: Ponds: Yes A licable WDR: <br /> Storm Dralna e S tem: $tOr i f it if astawatar and Stored in ex"st' <br /> ' WATER U8AOE D T ' <br /> Pfovide for(ofal water use a e/fu//bufldouf Number Pareons/Da Gallons/Parson/Da Total Gellons/De <br /> Domestic Water Usa e b Em to ees/Customers: <br /> T of Process/Ird a[ed Lands Total Gellons/De <br /> Process Water Usa e: <br /> Process Water Us e: <br /> Im etlon water use e: West r nsita use a mixed w/ manur <br /> Total Gallons Per Da <br /> PROPOSlQWELL LOCATION <br /> Well Location Address: os d wells f r r0 a t Ci[ <br /> Well Location APN: <br /> Wall Latitude: Well Lon dude: <br /> Flood Plain Desi nation: Well Elevation: <br /> PROPOSER WELL INFORMATION <br /> Well Total De th ft: Acres to be Served b Well: <br /> Use of Well: O Domestic �Irrigation �Small Public Water Supply �Municipal Public Water Supply O Industrial �Stock <br /> O Other: <br /> De [h of Corcoran Cle ft <br /> Pro osed Well Ca aci alttt: Estimatetl Pum in Rate al/min <br /> Anlici sled Pum in Schedule al/de Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before Janus 1,2020 acre-feet <br /> SITIND INFORMATION <br /> Dlstenes To Nearest H: Onsite: Offsite: Dlatanee To Nearest ft: Onsite: Offsite: <br /> Wastewater Treatment S atom: s hown O Sources of Contamination: <br /> Other Wells: Pand/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure: Novi able Waterwe <br /> Storm Dreina e S stem: Potential Recha a Features: <br /> GROUNDWATER INFGRMATION <br /> De th H: Source/Date of Reference: Orountlwater Subbasin: <br /> Cunent Depth[o Water: p Cosumnea Subbasin(2-22.16) <br /> Highest Depth to Water: 7,g SGMA, Within last 10 Bars of data �Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Daplh to Water: 12.75 SGMA, Within last 1 O Bars Of data �Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avanua I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www cehd.com <br /> t oft <br />