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/ POUtNcG SA N�J 0 Q U I N Environmental Health Department <br /> i:• 2� <br /> +l k" COUNTY <br /> Greatness grows here. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: MB&K, LLC <br /> Facility Address: 4300 MARIPOSA ROAD, STOCKTON, CA 95215 <br /> Street City Zip <br /> Facility Business Owner Name: GAGANDEEP SINGH Phone: 209-992-0140 <br /> Property Owner Name: MB&K, LLC, A CALIFORNIA LIMITED LIABILITY COMPANY Phone: <br /> Property Owner Address: 3316 HOWARD COMMON, FREMONT, CA 94536 <br /> Street City Zip <br /> WATER PROVISION INFORMATION_ <br /> WELL WILL BE USED FOR LANDSCAPE AND SERVE THE SINGLE BATHROOM <br /> 1. Number of houses, mobile homes, or other occupied buildings served by the water well(s): <br /> NO EMPLOYEES PER SHIFT. PARKING LOT FOR LONG HAUL TRUCK DRIVERS WITH VARYING SCHEDULE <br /> 2. Number of employees at the facility per shift: 0 Number of shifts: 0 <br /> 26 REPRESENTS THE PARKING SPACES HOWEVER THE LOT WILL NEVER BE FULL SINCE THE DRIVERS ARE LONG HAULERS WITH <br /> VARYING SCHEDULES.DEPENDING ON THE DRIVER'S ROUTE,THEY RETURN TO THE LOT ONCE A WEEK OR EVERY OTHER WEEK. <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 26 April 26 July 26 October 26 <br /> February 26 May 26 August 26 November 26 <br /> March 26 June 26 September 26 December 26 <br /> TRUCKERS ARE LONG HAUL DRIVERS WITH VARYING SCHEDULES <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January April July October <br /> February May August November <br /> March June September December <br /> 5. Number of yearlong residents: 0 <br /> 6. Number of residents per month, if variable: <br /> January 0 April 0 July 0 October 0 <br /> February 0 May 0 August 0 November 0 <br /> March 0 June 0 September 0 December 0 <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 /> i <br /> Facility Business/Property Owner: _ Date: <br /> Sign re <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />