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SAEnvironmentcxg Health Department <br /> N .,J04h, <br /> --COU NTY— <br /> Greatness crows here. <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: <br /> Project Address: Project APN: <br /> Applicant Name: Title: <br /> Applicant Address: Citylzip: <br /> Applicant Phone: Email:I lucky@relianceintermodal.com <br /> Property Owner Name: <br /> Property Owner Address: city/Zip: <br /> Property Owner Phone: Email: elevation-dc@outlook.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: 0 Surface Water(Affach 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 water usage at full buildout Number Persons/Day Gallons/Person/Day Total Gallons/Day <br /> Domestic Water Usage by Employees/Customers: . t <br /> Type of Process/Irrigated Lands Total Gallons/Day <br /> Process Water Usage: <br /> Process Water Usage: <br /> Irrigation Water Usage: Total Gallons Per Day: <br /> Well Location Address: PROPOSED WELL LOCATION ---Tcity:l <br /> Well Location APN: <br /> Weli Latitude: Well Longitude:1 <br /> Flood Plain Designation: Well Elevation:1 <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth Acres to be Served by Well:1 <br /> I I.. P" <br /> Use of We El Domestic F-1 Irrigation 0 Small Public Water Supply 0 Municipal Public Water Supply . 0 Industrial 0 Stock <br /> 0 Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacfty( al/ft): Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gallday): 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 /> Wells: <br /> Wastewater Treatment System:' Sources of Contamination: <br /> Other Wells: Pond/Lake: <br /> Sewer Line-- Stream/River: <br /> Lines: <br /> Animal or Fowl Enclosure: Navigable Waterwa <br /> Storm Drainage System:1 Potential Recharge Features: <br /> GROUNDWATER INFORMATION <br /> Depth(ft) SourcelDate of Reference: Groundwater Subbasin: <br /> Current Depth to Water: El Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: 0 Eastern San Joaquin Subbasin(5-22,01) <br /> Lowest Depth to Water: El 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 />