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SAN 1 Q AQ U I N Environmental Health Department <br /> -C(DUNTY- — 0 I <br /> WATER PROVISION DECLARATION <br /> Facility Business Name; Clements Compost <br /> Facility Address: 24376 E Brandt Road, Clements, CA 95277 <br /> Mot City Zip <br /> Facility Business Owner Name; Elder Creek Transfer& Recovery Inc., Corp. Phone: (760) 272•-1224 <br /> Property Owner Name: Gary C. Silva, Sr., Trustee Phone: (209) 993-6004 <br /> Property Owner Address: 11540 Clay Station Road, Herald, CA 95638 <br /> Street Clly Zip <br /> WATER PROVISION INFORMATION <br /> 1. Number of Mouses, mobile homes, or other occupied buildings served by the water well(s):0 <br /> 2. Number of employees at the facility per shift: 9 Number of shifts: <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, vlsltors and employees frequent the facility per month: <br /> January 25 April 25 July 25 October 25 <br /> February 25 May 25 August 25 November 25 <br /> March 25 June 25 9egtember 25 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 10 November 0 <br /> March 0 June 0 September 10 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 Busines Property Owner: Date; 31 <br /> sign, Q <br /> 1868 F. Hazelton Avenue l Stockton, Calitornia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br />