INSTRUCTIONS FOR COMPLETING THE

CALIFORNIA PUBLIC UTILITIES COMMISSION (CPUC)

WATER SUPPLY QUESTIONNAIRE (WSQ)

(FOR OTHER THAN A PUBLICLY-OWNED OR A MUTUAL WATER UTILITY)

This WSQ is to be completed for the subdivider by the water utility serving the area to certify that it has the ability to serve. This WSQ is to be filed as a standard advice letter, in conjunction with a service area extension, if applicable.

This WSQ must clearly show that:

(1) the subdivision is entirely within the certificated service area of the utility,

(2) an adequate supply of water is available¹ for the entire system in which the subdivision is situated, and

(3) adequate fire flow exists to meet the requirements of all existing customers, the fully developed subdivision, and the anticipated growth during the period of the subdivision development.

Supporting data, calculations, and conclusions are to be included in the WSQ filing. Supporting data (flow quantities, fire flow test, letter from fire protection agency, number of customers, etc.) should not be older than 1 year from the date of the WSQ filing. Calculations must be shown, where required.

Please note that all areas in this WSQ are to be completed, all attachments are to be provided, and the entire package must be verified. Failure to do any of these will mean automatic rejection of the WSQ.

The water utility should provide the information requested in the format as shown in this WSQ. Should the CPUC analyst need additional information, he/she will contact the utility.

Once completed, the WSQ is to be forwarded to:

CPUC

Attention: Water Division, Advisory Branch

505 Van Ness Avenue, Room 3106

San Francisco CA 94102-3298

Any questions regarding the WSQ may be directed to Fred Curry, Chief, at the above address or by telephone at (415) 703-1739.

NOTE: "Subdivision", as used in this WSQ, means that the subdivision for which this WSQ is being prepared.

This WSQ contains the following:

1. Information Cover Sheet.

2. Section A - Water Supply Available For Entire System At Present To Meet The Maximum Day Demand

3. Section B - Water Supply Requirements

4. Section C - Water Supply Conclusion

5. Section D - Minimum 2 Hour Total Flow Requirement

6. Section E - Minimum 2 Hour Total Flow Conclusion

7. Section F - Water Supply Summary

8. Section G- Supporting Calculations For Section A

9. Section H - Supporting Calculations For Section B

10. Section I - Supporting Documentation For Section D

11. Section J - Supporting Documentation For Section E

12. Section K - System Map And Proposed Subdivision Map

13. Certification and Verification Sheet

File No.: 615-4

CPUC

WATER SUPPLY QUESTIONNAIRE (WSQ)

(FOR OTHER THAN A PUBLICLY-OWNED, OR A MUTUAL, WATER UTILITY)

Water Supply Utility:

Utility Name:

Mailing Address:

City State Zip

Telephone No.: ( )

Fax No.: ( )

Contact Person:

Department of Real Estate (DRE) Information:

Mailing Address:

City State Zip

Telephone No.: ( )

Contact Person:

Assigned DRE No.:

Is a DRE letter required? (Yes) (No)

Subdivision to be Served:

Subdivision name:

Tract No.:

Location:

County:

Developer:

Number of Lots: Number of Acres:

Number of Dwelling Units:

The subdivision is to be fully developed by

(approximate date)

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A. WATER SUPPLY AVAILABLE FOR ENTIRE SYSTEM AT PRESENT TO MEET THE MAXIMUM DAY DEMAND

All sources referenced below must be listed individually along with their corresponding supply amounts and all supporting calculations must be shown in Section G.

(1) Flow available for this subdivision from all sources,
except distribution storage, on the day of maximum
demand [from Section G(1)] ^{*( ) = gpm}

^{Provide breakdown of residential and business customers in the system used to determine c factor in Section H(1):}

TYPE OF CUSTOMER	NUMBER OF CUSTOMERS
FLAT RATE
METERED RATE
TOTAL CUSTOMERS

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^{H. SUPPORTING CALCULATIONS FOR SECTION B (CONT.)}

^{[Water Supply Requirements]}

^{Justify c factor used in calculations (varies between 5 and 9 for flat rate service and 2 and 5 for metered service):}

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^{I. SUPPORTING DOCUMENTATION FOR SECTION D}

^{[Minimum 2 Hour Total Flow Requirement]}

^{Attach a letter from the applicable fire protection agency stating their fire flow requirement for Section D(1).}

^{NOTE: Data submitted should be no more than 1 year old.}

^{The flow standards for public fire protection purposes, set forth below, are those the CPUC considers appropriate for application on an average statewide basis. However, the CPUC recognizes that there are widely varying conditions bearing on fire protection throughout the urban, suburban, and rural areas of California. Therefore, the standards prescribed by the local fire protection agency or other prevailing local governmental agency will govern. Such local flow standards shall be provided whether greater or lesser than those set forth below.}

^{Land Use Minimum Flow}

^{Rural, residential with a lot density of}

^{two or less per acre, primarily for}

^{recreational and/or part-time occupancy. 250 gpm}

^{Lot density of less than one single-family}

^{residential unit per acre. 500 gpm}

^{Lot density of one or two single-family}

^{residential units per acre. 750 gpm}

^{Lot density of three or more single-}

^{family residential units per acre,}

^{including mobile home parks. 1,000 gpm}

^{Duplex residential units, neighborhood}

^{business of one story. 1,500 gpm}

^{Multiple residential, one and two stories}

^{light commercial or light industrial. 2,000 gpm}

^{Multiple residential, three stories or}

^{higher, heavy commercial or heavy}

^{industrial. 2,500 gpm}

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^{J. SUPPORTING DOCUMENTATION FOR SECTION E}

^{[Total Flow Conclusion]}

<sup>Attach any applicable fire flow test results for Section E(1)(i).

NOTE: Data submitted should be no more than 1 year old.</sup>

^{Attach the plan of the proposed water extension and flow availability at identified point(s) for Section E(1).}

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^{K. SYSTEM MAP AND PROPOSED SUBDIVISION MAP}

<sup>Attach a map which delineates the subdivision and which clearly shows that the subdivision is entirely within the certificated service area of the utility. Indicate on the map the locations of:

(a) all fire flow test(s) conducted
(b) all water sources
(c) all storage facilities
(d) all pressure zones</sup>

^{Attach a subdivision-specific map which clearly shows the details of the subdivision.}

^{NOTE: Data submitted should be no more than 1 year old.}

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^{CERTIFICATION AND VERIFICATION}

^{I am the owner, co-owner, or an officer in the corporation shown as the water public utility herein; I have read the statements in this document and known them to be true of my own knowledge, except as to the matters which are therein stated on information or belief, and as to those matters I believe them to be true.}

^{I declare under penalty of perjury that the foregoing is true and correct.}

^{Executed on , at , California.}

^{Signature (If corporate officer, also show title.)}

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