Laserfiche WebLink
DocuSign Envelope ID:E3D5593F-5BC1-4D54-972C 'D1746EA12 <br /> SAN J O A Q U I N Environmental Health Department <br /> ---C O U T Y----...--- <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Railport Logistics Inc. /Ranjit Gill <br /> Facility Address: 150 and 212 Frewert Road Lathrop 95330 <br /> Street City Zip <br /> Facility Business Owner Name: Ranjit Gill Phone: (209)640-9078 <br /> Property Owner Name: Ranjit Gill Phone: (209)640-9078 <br /> Property Owner Address: 403 Riley Court Tracy 95377 <br /> Street City 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: 2 —Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 100 April 100 July 100 October 100 <br /> February 100 May 100 August 100 November 100 <br /> March 100 June 100 September 100 December 100 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 20 April 20 July 20 October 20 <br /> February 20 May 20 August 20 November 20 <br /> March 20 June 20 September 20 December 20 <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 June September December <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 /> Docu^Signed by: <br /> Facility Business/Property Owner: f_rl-r G((� Date: 10/04/2021 <br /> —sSttgeae®s2aes... <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />