Laserfiche WebLink
SAN i,,JOAQUIN Environmental Health Department <br /> G OU NTY-- <br /> Leen tnc�s prows hrr.-. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Gurudwara Sahib Tracy <br /> Facility Address: 21356 Naglee Rd., Tracy, CA 95304 <br /> Street City Zip <br /> Facility Business Owner Name: Santokh Judge Phone: 925-487-8679 <br /> Property Owner Name: Santokh Judge Phone: 925-487-8679 <br /> Property Owner Address: 21 356 Naglee Rd., Tracy, CA 95304 <br /> Streai dry Zip <br /> WATER PROVISION INFORMATION <br /> 1. Number of houses, mobile homes, or other occupied buildings served by the water well(s):1 <br /> 2. Number of employees at the facility per shift: Number of shifts: <br /> 3- Total number of employees,customers,and visitors at the facility per month, if variable: <br /> January 1500 1 April900 July 900 October 1000 <br /> February 900 May 900 Auguat 900 November 1500 <br /> March I BOO I Juna 1900 1 September 1900 1 December 1500 <br /> 4_ Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 10 Aprll 4 July 4 October B <br /> February 4 1 May 14 1 August 4 November 110 <br /> March 14 1 June 14 1 September 14 1 Decembar lie <br /> 5. Number of yearlong residents: <br /> 6. Number of residents per month, if variable: <br /> January April July October <br /> February May August November <br /> March I I Juna September December <br /> l 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: Date: <br /> sl9 w- <br /> 1868 F. Hazelton Avenue I Stockton, California 952051 7 209 468-34201 F 209 464-0138 1 —sjcehd.com <br />