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SAN J O A Q U l N Environmental Health Department <br /> -- C0U \JTY <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 24707 S. Bird Road, Tracy, Ca 95304 Project APN: 250-100-060-000 <br /> Applicant Name Darren D. Man rum Title: <br /> Applicant Address: 24707 S. Bird Road City/ZiP: Tracy. Ca 95304 <br /> Applicant Phone 209-650-0085 Email:I drn(c0aturalsyneray.corn <br /> Property Owner Name Darren D. Mangrurn <br /> Pro ert•Owner Address: Cit /Zi : Tr Ca. 9 304 <br /> Property Owner Phone: Email:1 dm@naturalsynergy.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: Existing Well ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: Septic <br /> Process Wastewater Discharge: Ponds: Applicable WDR: <br /> Storm Drainage System: <br /> WATE"SAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Day GallonslPerson/Da Total Gallons/Da <br /> Domestic Water Usage-by Employees/Customers: 5 20 120 <br /> Typeof Processllrri ated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: I Drip system 300 <br /> Total Gallons Per Day: 420 <br /> PROPOSED WELL LOCATION <br /> Well Location Address: City: <br /> Well Location APN: <br /> Well Latitude: _ Well Lon itude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 Acres to be Served by Well: <br /> Use of Well ❑Domestic ❑Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(qal/ft):l Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/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: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Lines: Stream/River: <br /> Animal or Fowl Enclosure: Navigable Waterway: <br /> Storm Drainage System: Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: a ❑ Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: ❑Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: ❑ 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 />