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SAN JOAQUIN Environmental Health Department <br /> CCUI\TY <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Cannabis Facility <br /> Facility Address: 18846 St. Rt. 99 E Frontage Rd. _ Acampo 95220 <br /> St—re et City Zip <br /> Facility Business Owner Woodbridge Partners Inc. Phone; (209)986-4150 <br /> Name: Property Owner Woodbridge Partners Inc. Phone: (209) 986-4150 <br /> Name: Property Owner 119 E. Weber Ave. Stockton 95202 <br /> Street City Zip <br /> Address: <br /> WATER PROVISION INFORMATION <br /> 1. Number of houses, mobile homes, or other occupied buildings served by the water well(s):3 <br /> 2. Number of employees at the facility per shift: 25 Number of shifts: 3 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: _ <br /> January 75/day.1 delivery April 751day•1 delivery July 75/day+1 delivery October i 75+day.1 delivery <br /> February 75rday•1 delivery May 751day.1 delivery August 751day.1 delivery November 1751day.1 delivery <br /> March 751day.1 delivery June 751day•1 delivery September 751day.1 delivery December 75.+day.1 de0very' <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 31 April 30 July 31 October 31 <br /> February 28 May 31 August 31 November 30 <br /> March 31 June 30 September 30 December 31 <br /> 5. Number of yearlong residents: .Zero <br /> 6. Number of residents per month, if variable: <br /> January N/A April N/A July NIA October N/A <br /> February N/A May N/A August N/A November N/A <br /> March NIA June N/A September N/A December N/A <br /> I declare under penalty of perjury that the totiVients on this application are correct to my knowledge. It is the <br /> owner's responsibility to notify thi ff if the wafer provision information of the facility changes, <br /> Facility Bus inessfPrope rty Owner: _ _ . Date: 7-3a-g 24b <br /> Signature <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 1 1' 209 468-3420 1 F 2.09 464.0138 1 www.sjcehd.com <br />