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SAN JOAQUIN Environmental Health Department <br /> COUNTY - <br /> Iirwea4tne 'Ss y1ows hei1e . <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 1200 April 1200 July 1200 October 1200 <br /> February 1200 May 1200 August 1200 November 1200 <br /> March 1200 June 1200 September 1200 December 1200 <br /> 4 . Number of days that total number of customers , visitors and employees frequent the facility per month : <br /> January 30 April 30 July 30 October 30 <br /> February 30 May 30 August 30 November 30 <br /> March 30 June 30 September 30 December 30 <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 knowledge . It is the <br /> owner 's responsibility to notify this office if the water provision information of the facility changes . <br /> 2023 - 12 - 20 <br /> Faculty Business/ Property Owner : 61 Date : <br /> Signature <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 - 34201 F 209 464 - 0138 1 www . sicehd . com <br />