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JAN J U A Q U I N Environmental Health Department cou NTY - _ _ ... WATER PROVISION DECLARATION Facility Business Name : Tracy Hindu Community Center Facility Address : 11703 , W . Larch Road , Tracy , 95304 Street city zip Facility Business Owner Name : Bhanu S . Ravada Phone : ( 608 ) 381 - 5969 Property Owner Name : Mahadeva S . Ravada and Bhanu S . Ravada Phone :( 925 ) 336 - 5763 Property Owner Address : 5472 Starflower Way,_Livermore , California , 94551 Street city Zip WATER PROVISION INFORMATION 1 . Number of houses , mobile homes , or other occupied buildings served by the water well ( s ) : 2 2 . Number of employees at the facility per shift : 2 Number of shifts : 2 3 . Total number of employees , customers , and visitors at the facility per month , if variable : January 30 April 30 July 30October 30 - - - - - - - - ---- _ .. _ — ---- - -- -- - - - .. .. .... . . - — --- - - - February 30 May 30 August 30 November 30 March 30 — June _ 30 September 30 December 30 4 . Number of days that total number of customers , visitors and employees frequent the facility per month : January 20 April 20 July 20 October 20 February 20 May 20 August 20 November 20 March 20 June20 — September 20 December 20 5 . Number of yearlong residents : 4 6 . Number of residents per month , if variable : January 4 April 4 July October February 4 May August November - - - ---- - --- March 4 June September December declare under penalty of penury that the statements on this application are correct to my knowledge . It is the owner 's responsibility to notify this office if the water provision information of the facility changes . FacilityBusiness/ Pro ert Owner . Date : 10/24/2022 Signature es V ado 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 - 34201 F 209 464 - 0138 1 www . sicehd . com