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P-A �. � � � 45 <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY -- <br /> WATER PROVISION DECLARATION <br /> Facility Business Name : N /A <br /> Facility Address : 2900 E FREMONT ST , STOCKTON , CA 95205 <br /> Street City Zip <br /> Facility Business Owner Name : N /A Phone : <br /> Property Owner Name : LAKHWINDER SINGH Phone : ( 510 ) 754 - 7415 <br /> Property Owner Address : 19037 SANTA MARIA AVE , CASTRO VALLEY , CA 94546 <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 : Number of shifts : <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 April July October <br /> February May August November <br /> March June September December <br /> 5 . Number of yearlong residents : <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 /> � <br /> Facility Business/ Property Owner : L ,�, -e� � 5- Date .. 10 / 16/2023 <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 />