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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> PA2200153 <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: AT&T <br /> Facility Address: 976 S Gillis Road, Stockton, CA 95215 <br /> Street City Zip <br /> Facility Business Owner Name: AT&T Phone: (714)493-9935 <br /> Property Owner Name: SMITH ISOLEE TR ETAL Phone: <br /> Property Owner Address: PO BOX 55282, STOCKTON, CA 95205 <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):0 <br /> 2. Number of employees at the facility per shift: 0 Number of shifts: 0 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 1 April 1 July 1 October 1 <br /> February 1 May 1 August 1 November 1 <br /> March 1 June 1 September 1 December 1 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 1 April 1 July 1 October 1 <br /> February 1 May 1 August 1 November 1 <br /> March 1 June 1 September 1 December 1 <br /> 5. Number of yearlong residents: 0 <br /> 6. Number of residents per month, if variable: <br /> January 0 April 0 July 0 October 10 <br /> February 0 May 0 August 0 November •0 <br /> March 0 June 0 September 0 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 Business/Property Owner: ,"�� Date: 6/15/22 <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 />