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SQN � �QQU � Iv Environments. rlealtFl Department <br /> i.,� , r_, I �� <br /> WATER PROVISION DECLARATION <br /> Facility Business Names: 40Forty <br /> Facility Address: 3725 E Armstrong Road Lodi CA <br /> Jatinder Ohillori��^�� cnY zIP <br /> Facility Business Owner Name: Phones: <br /> Property Owner Names: Jatinder�hilion Phone: 209.612.0202 <br /> Property Owner Address: 1050 Hickory Hollow Street <br /> $gear CITY ZiP <br /> WATER PROVISION INFORMATION <br /> 1. Number of houses, mobile homes, or other occuplad buildings served by the water well(s): 1 <br /> 2. Number of employees at the facility par shift: 4 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility par month, if variable: <br /> January 600 April July October <br /> February BOO May August November II <br /> March 700 Junes September December <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility par month: <br /> January ApNI July Oetbbar <br /> February May August November <br /> Mamb 5 Junes September 7 pacambar <br /> 5. Number of yearlong resitlants: 2 <br /> 6. Number of residents per month, if variable: <br /> January Aprn Jmy a ootobe. z <br /> February May 2 August 2 Nov®mbar 2 <br /> March June S®pl®mGar 2 O¢aembar � <br /> /dec/era under pans/ty of perjury that the statements on this app/ication are correct to my know/edge_ /t is the <br /> owner's responsihi/ity to notify this office if the water provision information of the foci/ity changes. <br /> Facility Businass/Property Owner: �' �� Date: 2/11/21 <br /> slgnaw.a <br /> t 868 E. Hazelton Ayan ue � Stockton, California 95205 T 209 466-3420 I F 209 464-0138 wvvw.sjcand.com <br />