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SAN WOUIN Environmental Health Department <br /> �'DUNTY -- <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Tru by Hilton - Lodi <br /> Facility address: 6125 W Banner Street, Lodi CA 95242 <br /> st,�i city DO <br /> Facility Business Owner Name: Pr)I< NIaSP3'TA -111 Phone:�� - Ll8� - �'"i'�9 <br /> Property Owner Name: P NbS PTT'y Phone: (209) 5 -8900 <br /> Q22 <br /> s <br /> Property Owner Address: 17(�7 I.J FSE f^'l0 N T `5-" 5 "[-d�kT-0r 1 CALF <br /> Stree: <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: _2-6 _Number of shifts: 3 ^_ <br /> 3. Total number of employees,customers, and visitors at the facility per month, if variable: <br /> —� October <br /> January July <br /> February May August November <br /> _. _.- <br /> June Septembe� December <br /> I March � -- <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January April July October <br /> February May August November <br /> I Meq June f� September December <br /> 5. Number of yearlong residents: <br /> 6. Number of residents per month, if variable: <br /> Jul October <br /> January April July <br /> - "betFebruary May August <br /> _._ June <br /> September December I <br /> March _ <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 BusinesslProperty Owner: Date: a°Z °`ate <br /> slgnawre <br /> 1868 F. Hazelton Avenue 1 Stockton.California 95205 1 T 209 468-3420 1 F 209 464-0138 1 ww%v.sjcet,d.coM <br />