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�- SANJOAQUIN Environmental Health Department <br /> COUNT Y <br /> Ureatness grows here. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: 2662 N WILSON WAY , STOCKTON . C A 95205 Project APN: <br /> Applicant Name: SARFRAZ AHMAD TABISH Title: CEO <br /> Applicant Address:1012 WELLSWOOD CT , City/Zip: LODI CA 95240 <br /> Applicant Phone:209-663-3117 Email: <br /> Property Owner Name: SARFRAZ AHMAD TABISH <br /> Property Owner Address:1012 WELLSWOOD CT, City/Zip: LODI CA 95240 <br /> Property Owner Phone:209-663-3117 1 Email:lAutoMechusa@gmaii.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> California water Water Supply: ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: <br /> Process Wastewater Discharge: Ponds: Applicable WDR: <br /> Storm Drainage System: <br /> WATER USAGE DATA <br /> Provide for total wafer usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 5/day 0.5/P/D 2.5 G <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: <br /> Total Gallons Per Day: 2.5 <br /> Well Location Address: N/A Ci <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSE®WELL INFORMATION <br /> Well Total De th(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 (gal/ft): Estimated Pumpir Rate al/min <br /> Anticipated Pumping Schedule (gal/day): 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:j System: Potential Recharge Features: <br /> GROUNDWATER WFORIMATiON <br /> Depth(ft): SourcelDate of Reference: Groundwater Subbasin: <br /> Current Depth to Water: N/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 />