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PA2200248 <br /> 01' c� SANsJOAQUIN p <br /> f Environmental Health Department <br /> COUNTY <br /> r <br /> °qc �►`P 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 /> Street city Zip <br /> Facility Business Owner Name: Wodbridge Partners, Inc. Phone: 209-334-6613 <br /> Property Owner Name: Crothers Phone: 209-334-6613 <br /> Property Owner Address: 119 E. Weber Avenue, Stockton, CA 95202 <br /> Street city Z1P <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 Number of shifts: 1 <br /> 3. Total number of employees, customers,and visitors at the facility per month, if variable: <br /> January 2 April 2 July 2 October 2 <br /> February 2 May 2 August 2 November 2 <br /> March 2 I June 2 September 2 December 2 <br /> 4. Number of days that total number of customers,visitors and employees frequent the facility per month: <br /> January 20 April 20 July 20 October 20 <br /> February 20 May 20 August 20 November 20 <br /> March 20 June 20 September 120 December 120 <br /> 5. Number of yearlong residents: 0 <br /> 6. Number of residents per month, if variable: <br /> January o April 0 July _ 0 October 10 <br /> February 0 May 0 August 0 November 1 0 <br /> March p June 0 September 0 December IO � <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 IN ' e if the water provision information of the facility changes. <br /> A. L/il Facility Business/Property OwnDate: <br /> Signature <br /> 1868 E. Hazelton Avenue I Ston, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />