Laserfiche WebLink
Qu{,N c� SANAAM N Environmental Health Department <br /> COUNTY <br /> ��CtFOR�'\P Greatness grows here. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: California Balaji Temple (Datta Yoga Center) <br /> Facility Address: 12925 W. Bethany Road, Tracy, CA 95304 <br /> Street City Zip <br /> Facility Business Owner Name: Tulasi C.Tummala Phone: 408-786-8357 <br /> Property Owner Name: Datta Yoga Center Phone: 408-786-8357 <br /> Property Owner Address: 1366 Suzanne Court, San Jose, CA 95129 <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: 3 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> 1 January 14550 I April 14550 I July 14550 1 October 14550 1 <br /> 1 February 14550 1 May 14550 1 August 14550 I November 14550 1 <br /> 1 March 14550 1 June 14550 1 September 14550 1 December 14550 1 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> 1 January 130 1 April 13c 1 July 130 1 October 130 1 <br /> 1 February 130 1 May 130 1 August 130 1 November 130 1 <br /> 1 March 130 1 June 130 1 September 130 1 December 130 1 <br /> 5. Number of yearlong residents: 5 <br /> 6. Number of residents per month, if variable: <br /> 1 January 1 1 April 1 1 July 1 1 October 1 1 <br /> 1 February 1 1 May 1 1 August 1 1 November 1 1 <br /> 1 March 1 1 June 1 1 September 1 1 December 1 <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 /> Facility Business/Property Owner: /'�LLa Date: 1/20/2022 <br /> Signature <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />