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rr%ft. <br /> SAN J OA Q L _ N Environmel iI Health Department <br /> — —COUNTY— <br /> Greatness grows here. PA21o0275 <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Blackhawk Management Group LLC <br /> Facility Address: 7500 West Eleventh St., Tracy CA <br /> Street City Zip <br /> Facility Business Owner Name: Edgar RiZkaiiah Phone: (925) 548-7910 <br /> Property Owner Name: Navarra Family, LLC Phone: (650)333-5092 <br /> Property Owner Address: 475 Blewett Rd, Tracy, CA 95304 <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: 2.5 Number of shifts: 3 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 23,400 April 23,400 July 24,180 October 23,400 <br /> February 21,840 May 24,180 August 24,180 November 23,400 <br /> March 24,180 June 23,400 September 23,400 December 24,180 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 30 April 30 July 31 October 30 <br /> February 28 May 31 August 31 November 30 <br /> March 31 June 30 September 30 December 31 <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 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 /> L , <br /> Facility Business/Property Owner: "- x' �`-�` � Date: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />