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P%Clutv <br /> SAN 'JOAQUIN Environmental Health Department <br /> r- I k ,, . � 1i COUNTY <br /> ` `q Greatness grows here . <br /> WATER PROVISION DECLARATION <br /> Facility Business Name : Waterloo Morada Fire District Station 2 <br /> Facility Address : 4946 E Eight Mile Road <br /> Street City Zip <br /> Facility Business Owner Name : Waterloo Morada Fire District Phone : (209 ) 931 - 3107 <br /> Property Owner Name : Phone : <br /> Property Owner Address : <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 - 3 Number of shifts : <br /> 3 . Total number of employees , customers , and visitors at the facility per month , if variable : <br /> January 6 April 6 July 6 October 6 <br /> February 6 May 6 August 6 November 6 <br /> March 6 June 6 September 6 December 6 <br /> 4 . Number of days that total number of customers , visitors and employees frequent the facility per month : <br /> January 31 April 30 July 31 October 31 <br /> February 28 May 31 August 31 November 30 <br /> March 31 June 30 September 30 December 31 <br /> 5 . Number of yearlong residents : 3 <br /> 6 . Number of residents per month , if variable : <br /> January April July October <br /> February May August November <br /> March June September December <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 : ofx Date : 2 /20/2020 <br /> Signatur <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 46 & 3420 F 209 464 - 0138 1 www . sjcehd . com <br />