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--Address Line I—l'acsinrile <br />Business <br />--Mob. #-- <br />--Address Line 2— <br />Flonte <br />--l=ax No-- --Email Addr-- <br />-Address Line I-- <br />Mobile <br />practiceadmin@dronje.win <br />--City----S'f-- --'lip— <br />Emergency <br />--Vnrer. #-- <br />Add Additional Conlac[Q) <br />Emengency <br />—Emcr. #-- <br />--Contact Name-- <br />BIrSII1e55 <br />--Btis. #-- <br />-=]'lite-- <br />Home <br />--Fax No-- --]~mail ANT— <br />--Address Linc 1-- <br />Facsimile <br />--Mob H -- <br />--Address Line 2-- <br />Mobile <br />--2nd Email Addr- <br />--City-- --ST— --Zip-- <br />Entcrgcttcy <br />--Enter. N -- <br />Add Additional C:ontactM <br />—Contact ]`Dune-- <br />Business <br />--Bus.11-- <br />- l'idc— <br />Flonte <br />--l=ax No-- --Email Addr-- <br />-Address Line I-- <br />Facsimile <br />_Mob. N- <br />--Address Line 2-- <br />Mobile <br />--2nd Email Acldr- <br />-City-- - S*r-- --Zip-- <br />Emengency <br />—Emcr. #-- <br />CU14 M E 11 S:M <br />2. POPULATION SE11VED <br />Page 4 of 17 <br />❑ Do,ignaIcd <br />Operator in Charge <br />b Owner <br />0 Legal <br />Q Funding <br />® Contract Operator <br />{pick all <br />that apply} <br />❑ Administrative <br />❑ Operator <br />❑ Financial <br />❑ timergency <br />❑ Designated <br />El Wow Qua Iity <br />Operator in Charge <br />4 <br />❑ Owner <br />❑ Leda] <br />❑ Funding <br />❑ Contract Operator <br />(hick all <br />that apply) <br />❑ Administrative <br />❑ operator <br />❑ Financial <br />❑ Emergency <br />❑ Designated <br />❑ Water Quality <br />Operator In Charge <br />Nonuansiene <br />❑owner <br />❑ l..egal <br />❑Funding <br />❑ Contract Operator <br />Pupuln[inn <br />Type <br />Populatilrn <br />n <br />Annual Operating Period <br />Begin Date <br />Und Date <br />MW! <br />DD <br />Mlv1 <br />DD <br />Residential' <br />4 <br />Method Used to Determine Population: <br />11 <br />na <br />na <br />na <br />10ther v <br />'fransienO <br />25 <br />01 <br />01 <br />12 <br />31 <br />Nonuansiene <br />25 <br />{11 <br />01 <br />12 <br />31 <br />MM = month, in 2 -digit format DD = day, in 2 -digit fonnat <br />Descriptions: <br />rRcsideniial ® —report the number of persons who reside within llte water system service area ror more lban lip lf of the year (cxcludcs <br />lransicnt and nontransient populations). If year-round, lire Begin Dale wouId be 01101 and the Elul Dare would be IMI. <br />2,rratsient(D — report the number or persons who are at the venter system on die 60`r' husicsI day or the year (excludes residential and nontransient <br />populations. Report the Begin!Jule and End Dae if [lie Traitsient use is seasonal. <br />'Nontransient M— report ilia nuntber of tic persons who are at the water system 1'or aver 6 months per year (excludes residential and <br />transient populations). Report [lie Begin Date and F.rid Date if the Nontransient use is seasonal. <br />https:lldrinc.ca.govlearlDEEarRepoil.aspx?printable=yes&SurveyID=16&PwsID=CA39O l... 6/6/2016 <br />