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PA 210 0058 <br /> AN 1OAQU1I, Enuironmenta, i-leaith Department <br /> ——r_ r_,1_1 C'-J i Y <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Eagles Nest Harley Davidson <br /> Facility Address: 1352 Shaw Road Stockton, CA 95215 <br /> Street City Zip <br /> Facility Business Owner Name: Andrew Westbrook Phone: (916)929.4680 <br /> Property Owner Name: Andrew Westbrook Phone: (910) 929-4580 <br /> Property Owner Address: 18900 Harlan Road Lathrop, CA 95330 <br /> stree, city - -- z,r <br /> WATER PROVISION INFORMATION <br /> 1, Number of houses, mobile homes, or other occupied buildings served by the water well(s):0 <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 3313 April 336 July 336 October 336 <br /> February 336 May 336 August 336 November 336 <br /> March .336 June 3313 September 336 December 336 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January zc April 24 July 24 October 24 <br /> February 24 May N August 21 November 24 <br /> March 24 June 24 September 24 December 24 <br /> 5- Number of yearlong residents: 0 <br /> 6. Number of residents per month, if variable: <br /> January April July October <br /> February May August November <br /> March June septembet December <br /> 1 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 it the water provision information of the facility changes. <br /> Facility Business/Property Owner: Andrew Westbrook Dao;202ga323r,52 3,o a'°ak pate: 3/23/2021 <br /> SignRture <br /> 1868 E. Flaz@@ori Avenue I Slockton, Calitornia 95205 I T ?-M 468-3420 1 F 209 464-Q138 i www s1rphd cern <br />