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SAN JOAQUIN Environ mental Health Department <br /> COUNTY <br /> if o +l' <br /> ��`' Greatness grows here <br /> WATER PROVISION DECLARATION <br /> Facility Business Name : Liquor Sales <br /> Facility Address : 18700 CA- 883 Lockeford , 95237 <br /> Street City Zip <br /> Facility Business Owner Name : Parminder Kaur Phone : 661 - 900 - 9578 <br /> Property Owner Name : Parminder Kaur Phone : 661 - 900 - 9578 <br /> Property Owner Address : 8858 Latigo Court Roseville , CA 95747 <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 ) : 0 <br /> 2 . Number of employees at the facility per shift : 3 Number of shifts : 3 <br /> 3 . Total number of employees , customers , and visitors at the facility per month , if variable : <br /> January April July October <br /> February May August November <br /> March June September December <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 29 May 31 August 31 November 30 <br /> March 31 June 30 September 30 December 31 <br /> 5 . Number of yearlong residents : N /A <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 : lo /411� aa4- Date : 11 /06/2023 <br /> Signature <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 - 3420 1 F 209 464 - 0138 1 www . sjcehd . com <br />