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" ��, SAN JOAQUIN Environmental Health Department <br /> 'O._ co <br /> f� <br /> COUNTY <br /> °;��FaQaPGreatness grows here. <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: LUCKY DEOL TRUCK/ TRAILER PARKING <br /> Facility Address: STATE ROUTE 99 EAST FRONTAGE ROAD (APN 179-172-54 & 55) <br /> Street City Zip <br /> Facility Business Owner Name: GOLDEN PRIME INVESTMENTS, LLC Phone: (209) 321-9601 <br /> Property Owner Name: GOLDEN PRIME INVESTMENTS, LLC Phone: (209) 321-9601 <br /> Property Owner Address: 2172 DOYLE COURT, TRACY CA. 95377 <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: 8 Number of shifts: 2 <br /> 3. Total number of employees, customers, and visitors at the facility per month, if variable: <br /> January 8 April 8 July 8 October 8 <br /> February 8 May 8 August 8 November 8 <br /> March 8 June 8 September 8 December 8 <br /> 4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br /> January 8 April 8 July 8 October 8 <br /> February 8 May 8 August 8 November 8 <br /> March 8 June 8 September 8 December 8 <br /> 5. Number of yearlong residents: 0 <br /> 6. Number of residents per month, if variable: <br /> January 0 April 0 July 0 October 0 <br /> February 0 May 0 August 0 November 0 <br /> March 0 June 0 September 0 December 0 <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: %1 7 <br /> "at e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />