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SAN ] O A Q U I N Environmental Health Department <br />COUNTY <br />WATER PROVISION DECLARATION <br />Facility Business Name: SUNRISE TRUCKING- PATIO & STAIR ADDITION TO OFFICE BUILDING <br />Facility Address: 865 E ROTH ROAD, LATHROP CA 95231 <br />Street City Zip <br />Facility Business Owner Name: SUKHCHAIN GILL Phone: (209)495-0653 <br />Property Owner Name: SUKHCHAIN GILL Phone: (209)495-0653 <br />Property Owner Address: 865 E ROTH ROAD, LATH ROP CA 95231 <br />Street City Zip <br />WATER PROVISION INFORMATION <br />1. Number of houses, mobile homes, or other occupied buildings served by the water well(s): <br />2. Number of employees at the facility per shift: 8 Number of shifts: 1 <br />3. Tota <br />number of employees, customers, and visitors at the facility per month, if variable: <br />January i April _j July October ) 5 <br />February May August j November <br />March j June September December <br />4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br />January <br />April <br />July <br />October 14-1 E <br />February <br />May A, <br />August <br />November <br />March <br />June <br />September <br />December <br />5. Number of yearlong residents: N I L <br />6. Number of residents per month, if variable: <br />January <br />April <br />July <br />October <br />February <br />May <br />August <br />November <br />March <br />June <br />September <br />December <br />I declare under penalty of perjury that the statements on this application are correct to my knowledge. It is the <br />owner's responsibility to notify this office if the water provision information of the facility changes. <br />FacilityBusiness/Property <br />ili Owner: Date: <br />Signature <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />