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5 A N J 0 A Q U I N E,nv ronimentaMeetth Department <br /> C i-INTY . <br /> Well Exemption Statement <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit <br /> additional information prior to the issuance of a permit by the Environmental Health Department. This form must be <br /> completed to document the exemption criteria applicable for the new well application. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: _3 3 G :;ta,--z F,c 3 City: Tracy <br /> Well Location APN:1 2553-2017 <br /> Applicant Name: t-::r,njr,gs E,ro!;. Drilling�Co., Inc. Applicant Title: <br /> Applicant Address: 1930.Ladc Rd City: <br /> Applicant Phone: 9- - ; 5 Applicant email: wells4u(G>riFnrui .c> <br /> ..c <br /> Property Owner Name: ca _ter Reece <br /> Property Owner Address: :30E,5-_l 1 i, City: Tracy <br /> Property Owner Phone: 209-15402,-=dti'!: Property Owner email p rE-ecejr( cl rajl.�c� r <br /> EXEMPTION CRITERIA <br /> Well meets any of the following Exemptions: <br /> ❑ Well not located in a critically overdrafted basin. ❑ Tracy Subbasin (5-22.15) ❑ Cosumnes Subbasin (5-22.16) <br /> ❑ New well owner will be a de minimis extractor: maximum two acre-feet(651,702 gallons) or less per year being <br /> extracted for domestic purposes only. <br /> 1771 Replacement well with same extraction as the existing well that it is replacing. To meet this exemption the existing <br /> well must be destroyed under permit or continue to be used for domestic purposes with total domestic extractions <br /> remaining two acre-feet or less per year. <br /> Purposeluse of existing well: Ci Serve an existing residence ❑ Irrigate residential landscape <br /> New well estimated annual extraction volume: 6j0 <br /> Existing well estimated annual extraction volume: 50 <br /> Total Annual Domestic Use Volume: 650 <br /> ❑ Public agency that substantially meets or exceeds these requirements through another requirement of the law. In <br /> order to be exempt, the applicant shall document the laws that substantially meet or exceed these requirements <br /> and how the requirements of those laws were met. <br /> ❑ A city or county municipal well to provide water supply solely for residents of the city or county. <br /> I hereby certify that the information I have provided in this statement is accurate and truthful. <br /> Signed: 6 \. S Date: )ct. 22,2025 <br /> Statement completed by: 0 Well Driller ElWell/Property Owner I—] Other: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcwhd.cam <br /> i <br />