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10008. <br />SAN J O A Q U I N Environmental Health Department <br />Water Usage Information <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />1 of 2 <br />PROJECT INFORMATION <br />Well Location Address: <br />Application Number: <br />Well Location APN: <br />Application Type: <br />Project Address: 10948 S. Airport way, Manteca <br />Well Longitude: <br />Project APN: 204-020-04 <br />Applicant Name: Parry oalzell <br />Title: Pastor <br />Applicant Address: 10948 S. Airport way. <br />Acres to be Served by Well: <br />City/Zip: Manteca, Ca. 95336 <br />Applicant Phone: 209-565-9822 <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Email: perrydalzell@gmall.com <br />Proposed Well Capacity t <br />Property Owner Name: Central Valley Baptist Church <br />Anticipated Pumping Schedule a <br />Property Owner Address: 10948 s Airport way <br />City/Zip: <br />Manteca, Ca. 95336 <br />Property Owner Phone: 209-565-9822 <br />Distance To Nearest (ft): Onsite: Offsite: Distance To Nearest (ft): Onsite: Offsite: <br />Email: <br />parrydalzell@gmail com <br />Other Wells: <br />SERVICES INFORMATION <br />Sewer Lines: <br />Please provide description below: <br />Animal or Fowl Enclosure: <br />Navigable Waterway: <br />Water Supply: Existing Well <br />Potential Recharqe Features: <br />❑ Surface Water (Attach Water Rights Information) <br />Domestic Wastewater Disposal. septic <br />De th ft : Source/Date of Reference: Groundwater Subbasin: <br />Current Depth to Water: <br />Highest Depth to Water. <br />Lowest Depth to Water: <br />Process Wastewater Discharge: Ponds: <br />Applicable WDR: <br />Storm Drainage System: storm Pond <br />WATER USAGE DATA <br />Provide for total water usa a at lull buildout <br />Number Person slDa <br />GallonslPersonlDa Total Gallons/Da <br />Domestic Water Usage by Employees/Customers: varies <br />Type of Processllmi aced Lands Total GallonslDa <br />Process Water Usage: <br />Process Water Usage: <br />Irri ation Water Usage: <br />Total Gallons Per Da : <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />1 of 2 <br />PROPOSED WELL LOCATION <br />Well Location Address: <br />I city: <br />Well Location APN: <br />Well Latitude: <br />Well Longitude: <br />Flood Plain Designation: <br />Well Elevation: <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft):l <br />Acres to be Served by Well: <br />Use of Well: <br />❑ Domestic ❑ Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Claf: <br />Proposed Well Capacity t <br />Estimated Pumping Rate (gal/min): <br />Anticipated Pumping Schedule a <br />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: Offsite: Distance To Nearest (ft): Onsite: Offsite: <br />Wastewater Treatment System: <br />Sources of Contamination: <br />Other Wells: <br />Pond/Lake: <br />Sewer Lines: <br />Stream/River: <br />Animal or Fowl Enclosure: <br />Navigable Waterway: <br />Storm Drainage System:, <br />Potential Recharqe Features: <br />GROUNDWATER INFORMATION <br />De th ft : Source/Date of Reference: Groundwater Subbasin: <br />Current Depth to Water: <br />Highest Depth to Water. <br />Lowest Depth to Water: <br />❑ Cosumnes Subbasin (2-22.16) <br />❑ Eastern San Joaquin Subbasin (5-22.01) <br />❑ 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 www.sicehd.com <br />1 of 2 <br />