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S A%-J O A Q U IN Environmental Health Department <br /> Q <br /> !_'-i: COUNTY <br /> Greatness grows here. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Tech Truck and Auto <br /> Facility Address: 4082 South State Route 99 <br /> Street City Zip <br /> Facility Business Owner Name: CK Bros Carrier Inc. -Satbir Singh Rai Phone:M-MPNBMB25 <br /> Property Owner Name: CK Bros Carrier Inc. -Satbir Singh Rai Phone:01M 8-M25 <br /> Property Owner Address: 16869 Gold Nugget Trail. Lathrop CA., 953330 <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):1 <br /> 2. Number of employees at the facility per shift: 11 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 30 April 30 July 30 October 30 <br /> February 30 May 30 August 30 November X <br /> March 30 June 3Q September 3(D December 30 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January20 April 20 July 20 October 2® <br /> February 20 May 20 August 20 November 20 <br /> March 20 June 20 September 20 December 20 <br /> 5. Number of yearlong residents: m <br /> 6. Number of residents per month, if variable: <br /> January April July October <br /> February May August November <br /> March June September 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 /> . 6/30/2022 <br /> Facility Business/Property Owner: U� 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 />