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A NA A 0 N <br />0 U <br />:� <br />—C QU N r Y <br />Greatness grows. bq�e.i <br />Facility Business Name' :LOCKO <br />Facility Address: 2300 Tepee <br />Facility Business towner .blame - 0( <br />7 - <br />Property owner Name: Jesut,;M <br />Property Owner Address PO l3a, <br />1. Number of houses, ,mo ile <br />2. Number of employees <br />3. Total number of.erg_ ploye <br />January. .99 <br />Februery: 0 <br />99 <br />0 <br />l. -,I ".. MTM a, R. I IMa M- I <br />Envlronmt.antal Health Department <br />mil <br />1 Mater ied <br />Stockton CA 95205 <br />Phone: (209):329-1412. <br />Phone: (209) 329-1412 <br />980 'Lockeford:CA, 95237 <br />or other occupied buildings served by the water well(s) O <br />facility per shift-. 2 Number of shifts: <br />customers, 600 visitors at the facility per 'month, If, variable: <br />April 00 July go October 99 <br />may9 .�Wgust <br />99 November 99 <br />June 99 September 99 December go <br />of customer% visitors and employees frecluent the facility per month; <br />arsuary <br />26 <br />:; a3lerti <br />ji4 <br />2526 <br />Ootobbr <br />26 <br />Febr""g ry. <br />.2 <br />Paw <br />25 AUqUSt26 <br />l November <br />25 <br />Marah <br />26 <br />June <br />-T septembOr <br />.7i7 25 <br />December <br />25 <br />5. Number of yearlong reaid,' 0 <br />6, Number of residents per. to onth, Ovarldble-. <br />JMMY 0 i,-, April 0 <br />July <br />0 <br />October <br />0 <br />February 0: May 0 <br />Aupst <br />0 <br />November <br />0 <br />Maroh 0- i" 41inio 0. <br />sepumber <br />0 <br />December <br />O <br />I declareunder penalty of perju*.that, the statements on this application are correct to my knowledge. It is the <br />ownerS responslb!W to 4offy This office if the waWprovislon information of the facility changes. <br />Facility Business/Property net: mate: <br />3 <br />i 86 t.:Ha2efton Avenue fopittort, 0 <br />allfornia 95205 1 T 209 468-3420 F 2091464-0138 <br />8 1 www.sjcehdxorn <br />