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SAN J O A Q U I N Environmental Health Department <br /> C O U N T Y <br /> Greatness yiows hai c=, <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: SMVA Trust Religious Assembly <br /> Facility Address: 6001 Stanley Road, Stockton, CA 95215 <br /> Street City Zip <br /> Facility Business Owner Name: SMVA Trust Phone: 6507930054 <br /> Property Owner Name: SMVA Trust Religious Assembly Phone: 6507930054 <br /> Property Owner Address: 1312 North Rd, Belmont, CA 94002 <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):2 <br /> 2. Number of employees at the facility per shift: 2 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 11200 1 April 1 1200 1 July 11200 1 october 11zoo <br /> February I,— I May 11200 1 August 11200 1 November Ilzoo <br /> March 11200 1 June 11200 1 September 11200 1 December 1 1200 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 13G April 1 ao 1 July 130 1 Octaber 1 so <br /> February 13o May 13o 1 August 130 1 November 3o <br /> March I so June I September 13o I December sa <br /> 5. Number of yearlong residents: 2 <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 Know/edge. It is the <br /> owner's responsibility to notify this office if the water provision <br /> information of the facility changes. <br /> Facility Business/Property Owner: � Qi • "�`G Date: 2023-12-20 <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 />