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�z2oo ro � <br /> SAN J O A Q U I N Environmental Health Department <br /> --COUNTY <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Highway 88 Self Storage LLC <br /> Facility Address: 12941 Blossom Court Lockeford, CA 95237 <br /> Street City Zip <br /> Facility Business Owner Name: Diede Mini Storage, Inc. Phone: <br /> Property Owner Name: Diede Mini Storage, Inc. Phone: <br /> Property Owner Address: PO Box 1218 Woodbridge, CA 95258 <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): <br /> 2. Number of employees at the facility per shift: 1 Number of shifts: 2 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 20 April 40 July 50 October 30 <br /> February 20 May 40 August 50 November 30 <br /> March 30 June 50 September 30 December 20 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 5 April 5 July 5 October 5 <br /> February 5 May 5 August 5 November 5 <br /> March 5 June 5 September 5 December 5 <br /> 5. Number of yearlong residents: 1 <br /> 6. Number of residents per month, if variable: <br /> January 1 April 1 July 1 October 1 <br /> February 1 May 1 August 1 November 1 <br /> March 1 June 1 September 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: Q�ALDate: 3/17/2022 <br /> Sig ature <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />