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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> WATER PROVISION DECLARATION <br /> Facility Business Name : POLLARDVILLE SELF STORAGE <br /> Facility Address : 10464 99 FRONTAGE ROAD , STOCKTON , CA 95212 <br /> Street City Zip <br /> Facility Business Owner Name : JASBIR CHEEMA Phone : 209 - 323 - 9334 <br /> Property Owner Name : JASBIR CHEEMA Phone : 209 - 323 - 9334 <br /> Property Owner Address : 4053 E . MORADA LANE , STOCKTON , CA 95212 <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 : 2 Number of shifts : 1 <br /> 3 . Total number of employees , customers , and visitors at the facility per month , if variable : <br /> January 80 April 80 July 80 October 80 <br /> February 80 May 80 August 80 November 80 <br /> March 80 June 80 September 80 December 80 <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 20 December 20 <br /> 5 . Number of yearlong residents : 2 <br /> 6 . Number of residents 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 June 2 September 2 December 2 <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 /> n <br /> Facility Business/ Property Owner : Date : � L <br /> YVWV (,X11 ISignature <br /> U <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 - 0138 1 www . sjcehd . com <br />