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SAN J OAQ U I N Environmental Health Department <br /> COUNTY-- <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: CALIFORNIA YARDS, LLC <br /> Facility Address: 23751 SOUTH BIRD ROAD TRACY, CA 95304 <br /> Street City Zip <br /> Facility Business Owner Name: CALIFORNIA YARDS, LLC Phone: (510)638-8100 <br /> Property Owner Name: CALIFORNIA YARDS, LLC Phone: (510)638-8100 <br /> Property Owner Address: 10700 BIGGE STREET SAN LEANDRO, CA 94577 <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): <br /> 2. Number of employees at the facility per shift: 5 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 5 April 5 July 5 October 5 <br /> February 5 May 5 August 5 November 5 <br /> March 5 June 5 September 5 December 5 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January DAILY April DAILY July DAILY October DAILY <br /> February DAILY May DAILY August DAILY November DAILY <br /> March DAILY June DAILY September DAILY December DAILY <br /> 5. Number of yearlong residents: NSA <br /> 6. Number of residents per month, if variable: <br /> January April July October <br /> February May August November <br /> March June September December <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: / �/ y - - Date: %G`' Z <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 />