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x},�on <br />S A KJ 0 A 0 U I N Environmental Health Department <br />-' COUNTY <br />`cIuFof�aP Greatness grows here. <br />WATER PROVISION DECLARATION <br />Facility Business Name: Wodbridge Partners, Inc. c/o Jeff Crothers <br />Facility Address: 119 E. Weber Avenue, Stockton, CA 95202 <br />Facility Business Owner Name: Wodbridge Partners, Inc. Phone: <br />Property Owner Name: Jeff Crothers Phone: <br />Property Owner Address: 119 E. Weber Avenue, Stockton, CA 95202 <br />WATER PROVISION INFORMATION <br />209-334-6613 <br />209-334-6613 <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: 0 Number of shifts: 0 <br />3. Total number of emolovees. customers. and visitors at the facility ner month. if variable: <br />January 0 <br />April 0 <br />July 0 <br />October 0 <br />February 1 0 <br />1 May 0 <br />August 0 <br />I November t o <br />March 10 <br />1 June 0 <br />September 0 <br />December 0 <br />4. Number of days that total number of customers, visitors and employees frequent the facility per month: <br />January <br />0 <br />I Aprli 0 <br />July <br />10 <br />October 10 <br />February <br />0 <br />May 0 <br />August =o <br />November 10 <br />March <br />0 <br />June Jo <br />September <br />10 <br />December 10 <br />5. Number of yearlong residents: 0 <br />6. Number of residents per month, if variable: <br />January 0 <br />Aprll <br />0 July 0 October 0 <br />February 0 <br />May <br />0 August 0 November 0 <br />March 0 <br />June <br />0 September 0 December 0 <br />I declare under penalty of perjury that the <br />owner's responsibility to notify this <br />Facility Business/Property Owner: <br />is on this application are correct to my knowledge. It is the <br />9 water provision information of the facility changes. <br />Date: I I - I -CZ_ <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />