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,>·;,'.-'' ,;'\-. SAN ____ J OAO U IN Environmental Health Department 1-'r,. ·~·-.-1 -·-COUNTY-··----· WATER PROVISION DECLARATION Facility Business Name: _J_&_S_D_RA_v_· A_G_E __________________ _ Facility Address: 4250 EAST MARIPOSA ROAD STOCKTON 95215 Street City Zip Facility Business Owner Name: Sanjeev Toor & Jagdev Singh Phone: 209-814-5739 Property owner Name: Sanjeev Toor & Jagdev Singh Phone: 209-814-5739 Property Owner Address: PO BOX 6818 OAKLAND 94603 Street City Zip WATER PROVISION INFORMATION 1. Number of houses, mobile homes, or other occupied buildings served by the water well(s):_1 __ 2. Number of employees at the facility per shift: _4 ____ Number of shifts: _1 ___ _ 3. Total number of employees, customers, and visitors at the facility per month, if variable: January 9 April 9 July 9 October 9 February 9 May 9 August 9 November 9 March 9 -Jurj 9 September 9 December 9 4. Number of days that total number of customers, visitors and employees frequent the facility per month: January 20 April 120 July 20 October 20 February 20 May 20 August 20 November 20 March 20 June 20 September 20 December 20 5. Number of yearlong residents: _n_/a __ _ 6. Number of residents per month, if variable: January nla April July I I October February May August I November i I March June September I I December I declare under penalty of perjury that the statements on this application are correct to my knowledge. It is the owner's responsibility to notify this office if the water provision information of the facility chang,es. Facility Business/Property Owner: ____ <-""'--!~ ...... -_.""'"' ~-"P'-"',-7-_.,/~c~S:c..u~-"-30,-d',,.,,,_-~ __../ __ Date: lj/J Lf/2Z. . ~ure'/ .. ~ 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com