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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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WATERLOO
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3500 - Local Oversight Program
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PR0545859
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/3/2020 5:09:13 PM
Creation date
8/15/2019 11:29:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545859
PE
3528
FACILITY_ID
FA0003831
FACILITY_NAME
WATERLOO FOODMART
STREET_NUMBER
4315
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215-2305
APN
08710034
CURRENT_STATUS
02
SITE_LOCATION
4315 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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1 <br /> COMPLETE <br /> SECTION "PA'PLETE THIS SECTION ON DELIVERY <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 if Restricted Delivery is desired. X G��` � <br /> ■ Print yc�ir r dr n e reverse 0 Addressee so that4 e' r,g u n ClAgent <br /> e r -/you. ❑Addressee <br /> ■ Attach f iS i01 a ofie mailpiece, B. Received by(Printed Name) C. Date of Delivery <br /> or on the f if space permits. I Z ��lac/ <br /> 1. Article Add ed to: D. Is delivery address different from item 1? ❑Y <br /> If YES,enter delivery address below: Na <br /> Shell ! Products US <br /> c/o Pety Pineda <br /> 20945t5. Wilmington Ave. <br /> Carso�CA 90810 s. ,S Ice Type <br /> � Certified Mail® 13 Priority Mail Express- <br /> 13 Registered 0 Return Receipt for Merchandise <br /> Z {, n 0 Insured Mail 0 Collect on Delivery <br /> 1 <br /> \� •04015 UN"Ny9� f��. 4. Restricted Delivery?(Extra Fee) 0 Yes <br /> 2. Article Number <br /> (transfer from service labeg 7113 2250 0000 3397 9564 <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> COMPLETE <br /> ■ Complete items 1,2,and 3.Also complete A. Signature <br /> item 4 R ricted ever} s i red. © nt <br /> ■ Print y r re_ d e reverse X _- Addressee <br /> so that tsa: r g1 u� <br /> c d ou. B.rUei (Priv d Name) C. a <br /> T <br /> t of Delivery <br /> ■ Attach this card to the back of the mailpiece, /v� <br /> or on the front if space permits. <br /> D. Is delivery address different from item 1? 0 Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: 0 No <br /> William & Cathy Norby <br /> 2302 Woodlake Cir. <br /> Lodi, CA 95242 3. se Ice Type <br /> IV Certified Mail® 0 Priority Mail Express' <br /> 0 Registered 0 Return Receipt for Merchandise <br /> 0 Insured Mail 0 Collect on Delivery <br /> �! -1315 L j'w I/ , 4. Restricted Delivery?(Extra Fee) El Yes <br /> 2. Article Number r`J� 7013 2250 0000 3397 9588 <br /> (Transfer from service label) <br /> PS Form 3811,July 2013 Domestic Return Receipt <br /> i <br />
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