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' $A N ,J Q A Q U l N Environmental Health Department <br /> s COUNTY <br /> Grectness groins mere. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: AutoMech <br /> Facility Address: 2662 N WILSON WAY , STOCKTON . C A 95205 <br /> Street City Zip <br /> Facility Business Owner Name: SARFRAZ AHMAD TABISH Phone: 209-663-3117 <br /> Property Owner Name: SARFRAZ AHMAD TABISH Phone:209-663-3117 <br /> Property Owner Address: 1012 WELLSWOOD CT , LODI CA 95240 <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 Building <br /> 2. Number of employees at the facility per shift: 1 Number of shifts: 1 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 6 April 6 July 6 October 6 <br /> February 6 May 6 August 6 November 6 <br /> March 6 June 6 September 6 December 6 <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 24 April 24 July 24 October 24 <br /> February 22 May 24 August 24 November 24 <br /> March 24 June 24 September December 24. <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 /> e <br /> Facility Business/Property Owner: Date: 2/23/2022 <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 />