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PA2100045 <br /> S A N J O A Q U I N Environmental Health Department <br /> C_o U 1\1 1 Y <br /> WATER PROVISION DECLARATION <br /> Facility Business Name: Jahant Woods Cellars Water System <br /> Facility Address: 1525 Jahant Road,Acampo,CA 95220 <br /> City <br /> Facility Business Owner Name: Randall Lange Phone: (209)479-1675 <br /> Property Owner Name: Same as above Phone: <br /> Property Owner Address: Same as above <br /> SUc,t City 2iP <br /> WATER PROVISION INFORMATION <br /> 1. Number of houses,mobile 1lotnes,or other occupied buildings served by the water well(s): 5 <br /> 2. Number of employees at the facility per shill: 12 Number of shifts. 3-August-November <br /> 3. Total number o em loyee ,customers,and visitors at the facility per month,it variable: <br /> PF. <br /> nnuary24 Aprli 2q July 50 October 89 <br /> bruary 24 May 24 August 89 Novembrr 89 <br /> mch 24 June 24 Seplembor 89 December .90 <br /> 4. Number of days ilia[total number of customers,visitors and a to ee frequent the facility per month: <br /> January 23 April 30 July 31 October 30 <br /> February 28 May 31 August 31 November 25 <br /> Murch 31 June 30 September 30 December 23 <br /> There are 20 or more customers that visit every day throughout the year,except when closed In December&January <br /> 5. Number of yearlong residents: i <br /> 6. Number of residents per month,11 variable: <br /> January April — July October <br /> February May August November <br /> March June September December J <br /> I declare under penally of perjury that tho statements on this application are correct to my knowledge. 11 is thn <br /> owner's responsibility to notify this office if the wafer provision information of the facility changes. <br /> Facility Business/Properly Owner: c ' ��% .% Dale: <br /> sa,rcrtrau� j. j. <br /> 1868 E. Hazellon Avenue 1 Slocklon,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.corn <br />