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PA2200243 SAN J 0 A Q U I N Environmental Health Department C O U N T Y------ Greatness grows here. Water Usage Information PROJECT INFORMATION Application Number: Application Type: off premise sign Project Address: 25355 North Highway 99 Frontage Road Accampo,CA 95220 Project APN: 005-143-02 Applicant Name: Orion outdoor Media Title: coo Applicant Address: 3161 Cameron Park Dr.#221 CI /ZI : Cameron Park,CA 95682 Applicant Phone: 916-212-0243 Email: chanes@orionoutdoor.com Property Owner Name: James Adams Property Owner Address: 824 Atlantic Street Ci /ZI Roseville,CA 95678 Property Owner Phone: 831-682-6783 1 Email: SERVICES INFORMATION Please provide description below: N/A-FOR A SIGN Water Supply: ❑ Surface Water(Attach Water Rights Information) Domestic Wastewater Disposal: Process Wastewater Discharge: Ponds: A plicable WDR: Storm Drainage System: WATER USAGE DATA Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da Domestic Water Usage by Employees/Customers: N/A-FOR A SIGN Type of Process/Irrigated Lands Total GallonslDa Process Water Usage: Process Water Usage: Irrigation Water Usage: Total Gallons Per Da PROPOSED WELL LOCATION Well Location Address: N/A-FOR A SIGN I Cit Well Location APN: Well Latitude: Well Longitude: Flood Plain Designation: Well Elevation: PROPOSED WELL INFORMATION Well Total Depth(ft):IN/A-FORASIGNI Acres to be Served by Well: Use of Well: ❑ Domestic ❑Irrigation ❑Small Public Water Supply ❑Municipal Public Water Supply ❑ Industrial ❑Stock ❑Other: Depth of Corcoran Clay(ft): Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume(acre-feet): Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): SITING INFORMATION Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: Wastewater Treatment System: Sources of Contamination: Other Wells: 160 ft from sign column 378,300 from sign Wumn Pond/Lake: Sewer Lines: 130 ft.from sign column 290 from sign column Stream/River: Animal or Fowl Enclosure: Navigable Waterwa Storm Drainage System: Potential Recharge Features: GROUNDWATER INFORMATION Depth(ft): Source/Date of Reference: Groundwater Subbasin: Current Depth to Water: 80 ft 4/16/99 Advanced Geo Envi ron mental ❑Cosumnes Subbasin(2-22.16) Highest Depth to Water: ❑Eastern San Joaquin Subbasin(5-22.01) Lowest Depth to Water: ❑Tracy Subbasin(5-22.15) 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com 1 of 2