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�'. SANs,��QQU�N Environmental Health Department <br /> ' ��� -._--C CJ LJ N T Y .-__-_ <br /> Grsntn }rows hEre. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: TCU by Hilton - LOdI <br /> Facility Address: 67 25 W Banner Street, Lodi CA 95242 <br /> sit cavy vP <br /> Facility Business Owner Name: PDI< F-tt1S P's i1) S TY Phone: 2Dq_�-l8A — 6"719. <br /> Property Owner Name: pf�l: u^"P�Tf':! T"r-"�/ Phone: (209) 522-8900 <br /> Property Owner Address: sve®, J T S T Sy TO C.1�T01�1 CA — �i6'Z>7 3 <br /> CI,Y P <br /> WATER PROVISION INFORMATION ' <br /> 1- Number of houses, mobil¢homes, or other occupied buildings served by the water well(s):0 <br /> 2. Number of employees at the facility per shift: 2-6 Number of shifts: 3 <br /> 3. Total number of employees, customers, and visitors at the facility par month, if variable: <br /> January April JUIY Oeaobar <br /> February MaY August November <br /> Marsh Juno Seplembar Daeembar <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January April July Oatebar <br /> Fobruery May August November <br /> March Juna BePtamber December <br /> 5. Number of yearlong residents: <br /> 6. Number of residents par month, Ifvariabla: <br /> January Pprll JUIY Oatebar <br /> Fabmary May August November <br /> March Juna 8aplambar - December ' <br /> /dec/are under pans/ty of perjury that the statements on this app/ication are correct to my know/edge. /t is the <br /> owner's rasponsibi/ity to notify this o^ffice if the water provision information of the foci/ity changes. <br /> T <br /> Facility Business/Property Owner: sle�amre Data: S�a�-10��Z <br /> 1868 E. Hazelton Avanua I Stockton,California 95205 I T 209 466-3420 F 209 464-Ot36 www-sjcand.cOm <br />