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IlDi <br /> U-96 �__ ? 0 0 <br /> SAN JOAQUIN Environmental Health Department <br /> -COU NTY-- <br /> Greotness grows here. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: O'Reilly Auto Parts <br /> Facility Address: 12999 Blossum Ct. Lockeford 95237 <br /> Street City Zip <br /> Facility Business Owner Name: O'Reilly Auto Enterprises, LLC Phone: 417-862-0558 <br /> Property Owner Name: Diede Pending LLC r Phone: <br /> Property Owner Address: P.O. Box 1007 Woodbridge 95258 <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: 5 ,Number of shifts: 2 <br /> 3. Total number of employees,customers,and visitors at the facility per month, if variable: <br /> January 1570 April 1570 July1570 October 1570 <br /> February 1570 May 1570 August 1570 November 1570 <br /> March ;1570 June .1570 Septamber 11570 December 1570 <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 30 Aprll 30 July 31 October 31 <br /> February 29 May 31 August 31 November 30 <br /> March 31 June 30 September 30 December 30 <br /> 5. Number of yearlong residents: N/A <br /> 6. Number of residents per month, if variable: <br /> January NIA Aprll N/A July N/A October N!A <br /> February INA I May I N/A August N/A November NIA <br /> March I N/A June N!A September NIA December I NIA <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 thew er provision information of the facility changes. <br /> Facility BusinesslProperty Owner. Date: GL- <br /> stv.attire <br /> 1868 E. Hazelton Avenue Stockton,California 95205 1 T 209 468.3420 F 209 464-0138 1 www.sjcehd.com <br />