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iyl unr nr' ' ;; SANd0AQUIN Environmental Health Department COUNTY--- Greatness grows here. Water Usage Information Total Gallons Per Day: 1 PROJECT INFORMATION Well Location Address: '5002-2- enc C 5 304- Tc -it : Tyke - Application Number: Application Type: Well Latitude: (o Project Address: 2 ' ti. 33 c C Project APN: 255 It Applicant Name: h Acres to be Served by Well: Title: r 1 ADomestic ❑ Irrigation ❑ Other: Applicant Address: m PNa I p City/Zip: CA l Applicant Phone: 2 _ Q Email: @ 2 Estimated Annual Extraction Volume acre-feet : 6.2'1 Estimated Cumulative Extraction Volume before January 1, 200 (acre-feet): Property Owner Name: \�>a t- S c6 Distance To Nearest (ft): Onsite: Offsite: Distance To Nearest (ft): Onsite: Property Owner Address: ewpire 2 203 31C1 Cit IZi : 'C hQN. 92-1 %0 Property Owner Phone: Pond/L-ales: 4 I Email: jw tv &MMOOaef: K/A —xGC `k IVA SERVICES INFORMATION Navigable Waterway: 14 VA Please provide description below: t Potential Rechar a Features: K /A Water Supply: rAAW � on 5� ❑ Surface Water (Attach Water Rights Information) Domestic Wastewater Disposal: S "c e 5. Current Depth to Water: Highest Depth to Water: (drO _, �, 0_r Process Wastewater Discharge: Ponds: .�tn��..� � s��-�. _2flLtst r ; .. :.osumnes Subbasin (2-22.16) �� G Wok kS �\ El Eastern San Joaquin Subbasin (5.22.01) ,S p \� Wor\x-s 'Z9l (o Tracy Subbasin (5-22.15) 0 5 A licable WDR: Storm Draina e System: r 0 WATER USAGE DATA Provide for total water usage Number_Pers_ons/Day Gallons/Person/Day 2Q Total Gallons/Da \ p Domestic Water Usage b Employees/Customers: 2Usage: Type of-Process/Irrigated Lands Total Gallons/Day Process Cj Process D Irrigation Water Usage: (go Total Gallons Per Day: 1 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ) F 209 464-0138 ) www.sicehd.com 1 of 2 s1 M PROPOSED WELL LOCATION Well Location Address: '5002-2- enc C 5 304- Tc -it : Tyke - Well Location APN: Q y . Well Latitude: (o 2 Well Longitude: r 2 O 31 Flood Plain Designation: Well Elevation:1 G15.0 PROPOSED WELL INFORMATION Well Total Depth (ft): -jj,5'0 T Acres to be Served by Well: Use of Well: ADomestic ❑ Irrigation ❑ Other: ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): UAV-vno.wn Proposed Well Capacity (gal/ft): v,Ah n Estimated Pumping Rate allmin : Q Anticipated Pumping Schedule (gal/day): 2 Estimated Annual Extraction Volume acre-feet : 6.2'1 Estimated Cumulative Extraction Volume before January 1, 200 (acre-feet): SITING INFORMATION OfttA J -M Distance To Nearest (ft): Onsite: Offsite: Distance To Nearest (ft): Onsite: Offsite: Wastewater Treatment System: 12-1510 31C1 dQ',j- Sources of Contamination: OtherWells: K IL Pond/L-ales: 4 Sewer Lines: jw tv &MMOOaef: K/A —xGC `k IVA Animal or Fowl Enclosure: ty Navigable Waterway: 14 VA Storm Draina e S sy tem; t Potential Rechar a Features: K /A GROUNDWATER INFORMATION Depth (ft): Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: Highest Depth to Water: (drO _, �, 0_r ?m 5 .�tn��..� � s��-�. _2flLtst r ; .. :.osumnes Subbasin (2-22.16) �� G Wok kS �\ El Eastern San Joaquin Subbasin (5.22.01) ,S p \� Wor\x-s 'Z9l (o Tracy Subbasin (5-22.15) Lowest Depth to Water: ..(DO' _ 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ) F 209 464-0138 ) www.sicehd.com 1 of 2 s1 M