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SAN J O A Q U I i Environments, Health Department <br /> COUNTY <br /> pAZOQ01 4a <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Clements Compost <br /> Facility Address: 24376 E Brandt Road, Clements, CA 95277 <br /> Street City Zip <br /> Facility Business owner Name: Elder Creek Transfer& Recovery Inc., Corp. Phone: (760)272-9224 <br /> Property Owner Name: Gary C. Silva, Sr., Trustee Phone: (209) 993-6004 <br /> Property Owner Address: 11540 ClayStation Road, Herald, CA 95638 <br /> Street Ciiy 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: 9 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January April July October <br /> February May August November <br /> March June September December <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 25 1 April 25 July 25 October 25 <br /> February 25 May 25 August 25 November_ 25 <br /> March 125 June 25 September 125 December 25 <br /> 5. Number of yearlong residents: 0 <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 o <br /> 1 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 Busines Proporty owner: Date: <br /> Sig a <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcetid.com <br />