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PA2100204 <br /> AN J QUIN Environmental Health Department <br /> C 0 L.) r`i I-l ......_..._ <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: FRENCH CAMP TRUCK TERMINAL <br /> Facility Address: 25 E. FRENCH CAMP RD, FRENCH CAMP, CA 9. 5231 <br /> Street City Zip <br /> Facility Business Owner Name: Gurbinder Mangat Phone: (408)355-5700 <br /> Property Owner Name: Gurbinder Mangat Phone: (408)355-5700 <br /> Property Owner Address: 17900 MURPHY PARKWAY, LATHROP, CA 95330 <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):2 <br /> WELL SERVING LANDSCAPE FIND PROPOSED GUARD SHACK AND OFFICE TRAILER <br /> office=1/shift office=2 shifts/day <br /> 2. Number of employees at the facility per shift:guard= 1/shiftNumber of shifts: guard =3 shifts/day <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 5 April 15 July 15 October 15 <br /> February 5 May 5 August 5 November 15 <br /> March 5 June 15 September 1 5 December 15 <br /> VALUE ENTERED REPRESENTS EMPLOYEE COUNT.DIFFICULT TO ACCOUNT FOR TRUCK DRIVERS <br /> NTERf G/LEAVING SIT EAS THEIR SCHEDULE VARIES AND IS DEPEN ENT O DRIVER'S ROUTE <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 'DAILY April DAILY July I DAILY I October DAILY <br /> February I DAILY May DAILY August DAILY I November DAILY <br /> March `DAILY June DAILY J September I DAILY I December 'DAILY <br /> 5. Number of yearlong residents: N/A <br /> 6. Number of residents per month, if variable: N/A <br /> January April July October <br /> February May i 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 /> Facility Business/Property Owner: Date: f b _,21 <br /> r ',_fL'" �ignature <br /> 1 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br />