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SAN JOAQUi . , Environmentai Health Department <br /> COUNTY <br /> WATER VISI ® DECLARATION M" ,M� Mvi <br /> Facility Business Name : Blyden Limited Partnership , a California Limited Partnership <br /> Facility Address : 4343 N Wilson Way, Stockton CA . 95205 <br /> Street city Zip <br /> Facility Business Owner Name : Phone • <br /> Property Owner Name . Phone : <br /> Property Owner Address : <br /> Street <br /> city Zip <br /> WATERINFORMATION <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 : 3 Number of shifts : 2 <br /> 3 . Total number of employees , customers, and visitors at the facility per month , if variable : <br /> January 100 April 150 July 100 October 100 <br /> February 110 May 150 August 150 November 150 <br /> March 140 June 165 September 150 December 145 <br /> 4 . Number of days that total number of customers, visitors and employees frequent the facility per month : <br /> January 140 April 155 July 150 October 160 <br /> February 150 May 160 August 165 November 160 <br /> March 155 June 170 September 165 December 145 <br /> 5 . Number of yearlong residents : <br /> 6 . Number of residents per month , if variable : <br /> January 0 April 0 July 0 October 0 <br /> February 0 May 0 August 0 November 0 <br /> March 0 June 0 September 0 December 0 <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 /> Facility Business/ Property Owner : Date : <br /> Signature <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 1 www . sjcehd . com <br />