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102200075 <br /> SAN J O A Q U I N Environmental Health Department <br /> ---COUNTY -- - <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Garcia Grow Co LLC. <br /> Facility Address: 407 N. Alpine Rd. Stockton CA 95215 <br /> Street City Zip <br /> Facility Business Owner Name: Justin Garcia Phone: (415)254-1975 <br /> Property Owner Name: Dave E. Smith & Irene Smith Phone: (209) 368-6618 <br /> Property Owner Address: 8315 Orford Road, Stockton, CA 95215 <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):3 <br /> 2. Number of employees at the facility per shift: 3 Number of shifts: 3 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January I April July October <br /> i <br /> February May August November <br /> March I June September ! December <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January April July October <br /> February May August 1 November 1 <br /> March 1 i June 1 September 1 December 11 <br /> 5. Number of yearlong residents: 2 <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 /> 1 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 /> Cu�lli+v R�i�lnocc/l7rnr�erty r)%Ainer- c Z.-I ....: nate 03/04/22 <br /> Signature <br /> 1368- E Hazsitor, ,%/gnue ; Sto6tcn, California 95205 1 T 209 463-3420 1 F 2()9 464-0'33 1 VVW%N.sjcehd.;om <br />