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SAN JOAQUIN Environmental Health Department <br /> I:-- ou rJ TY - <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> App=Number: A lication T e: <br /> Pro'ect Address: cru.....SaW...1...Naglaa Rd..Tracy.CA B530a Pro'ect APN: zlzoso-o1 <br /> Alicant Name: samakn dodge Title: <br /> A Il.t Address: QuruUwara SaM1ib,21356 Naglaa Rtl_Tracy,CA.s.— City/Zip; Tracy,CA 95304 <br /> licant Phone: 9z5ea7-as79 Email: <br /> Pro art Owner Nam- c0rvdwara semb.Tracy <br /> P==ar <br /> Address: Gurutlwara sablb,21356 Naglca—.Tracy,—85304 Cj /ZI Tracy,GA g63g4 <br /> Property Owner Phone:1 Bz 8 -6678 Email: <br /> SERVICES INFORMATION <br /> Please pmvide description below: <br /> Water Supply: Proposed Onsite Water Well O Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Dis ,sal: Proposed onsite..p...y.—ream clam <br /> Process Wastewater Discharge: Ponds: A licable WDR: <br /> Storm Drainage System: onsaa alo-retan6on Basin and.1t.glo ax,altcM1 along Le w L.1—Road <br /> WATER USAGE DATA <br /> Provide for total water usage at full bulfdout rs <br /> Number Peons/Da Gallons/Person/Da Total Gallons/D <br /> Domestic Water Usage b Employees/Customer.: 1zs 30 37so <br /> Type of Process/irri gted Lands Total Gallons/Da <br /> ProcessWater Usage: <br /> Process Water U,,- e: <br /> Irrigation Water Usage <br /> Total Gallons Per D <br /> PROPOSED WELL LOCATION <br /> WBII LOCBtIOnAddress: 21358 Negiae Rd.. CIL hvcy.CA 88304 <br /> Well Location APN: 212-050-01 <br /> Well Latitude: 37-4ss3.43-ry Well Lon nude: 1z1.27.39.54•w <br /> Flood Plain Designation: we(er=e-13-) Well Elevation: 1o.50l co <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 Tc.a dele.naned Acres to be Served by WGI[:l 8.49 Acres <br /> Use of Well: M Domestic M Irrigation E3 Small Public Water Supply O Municipal Public Water Supply O Industrial CI Stock <br /> E3 Other. <br /> Depth of Corcoran ClayR <br /> Pro sed Well Ca aci al/ft: Estimated Pum in Rate al/min <br /> Anticipated Pum in Schedule al/da Estimated Annual Extraction Volume acre-feet <br /> Estimated Cumulative Extraction Volume before January 1 2020 acre-feet <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: I Offsite: I I Distance To Nearest ft: Onsite: Offsite_ <br /> Wastewater Treatment S stem: lees nor.,rasa,clam Sources of Contamination: <br /> Other Walls: Pond/Lake: wA <br /> Sewer Lines: Stream/River: N— <br /> Animal or Fowl Enclosure: Nevi able Waterwa : <br /> Storm Drains e S stem: NrA Potential Rechar a Features: 4e m.eax.u�u•�e-�• <br /> GROUNDWATER INFORMATION <br /> De th ft: Source/Date of Reference: I Groundwater Subbasin: <br /> Current Depth to Water. To 5e aere.mir.ed O Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: O Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water. E3 Tracy Subbasin 5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 --sicehd.com <br /> 1 of 2 <br />