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SU0007935_SSCRPT
EnvironmentalHealth
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SU0007935_SSCRPT
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Entry Properties
Last modified
12/7/2020 4:28:35 PM
Creation date
9/4/2019 6:37:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0007935
PE
2622
FACILITY_NAME
PA-0900192
STREET_NUMBER
751
Direction
E
STREET_NAME
FOREST LAKE
STREET_TYPE
RD
City
ACAMPO
APN
00313001
ENTERED_DATE
10/5/2009 12:00:00 AM
SITE_LOCATION
751 E FOREST LAKE RD
RECEIVED_DATE
9/28/2009 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\F\FOREST LAKE\751\SU0007935\SSC RPT.PDF
Tags
EHD - Public
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SAN JOAQUIN COUNTY / <br /> 2868 E . HAZELTON AVENUE V <br /> STOCKTON, CA 95205 <br /> Web URL :www. co.san-joaquin . ce , us.fagcomm <br /> E-Mail : <br /> Office : (209 ) 468-3300 Recorder (NOI ) : ( 209 ) 468-3300 FAX: ( 209 ) 468--3330 <br /> RESTRICTED MATERIALS PERMIT --- _ PERMIT # : -39-05-3904457 <br /> County HQ District # : F <br /> ROUND VALLEY RANCHES Expiration rate: 12/31.12005 <br /> P 0 BOX 885 Effective Date : 01/08/2003 <br /> VICTOR, CA 95253 <br /> JONATHAN WETMORE Home : 2093696805 <br /> 115 N SCHOOL ST SUITE 5 Shop: (209 ) 369-6505 <br /> LODI , CA 95240- Fax: 2093599832 <br /> Mobile <br /> ------ ------------ <br /> Permittee Type r Permit Type Possession NOI Method of Submission <br /> ------------- --_ _y_---- -------------- -------------------------- <br /> Private App I X I Seasonal I XiFoss & Use X Phone <br /> X Fax Y <br /> Q A Cert I I Job I I Poss only I I Box I I Modem 1XI <br /> Ag PCO I I In Person IXI Web 1XI <br /> Non -Ag I I NOI required 24 hours prior to application <br />! Non--Ag Use : None <br /> Conditions : PW' <br /> I-understand that this permit does not relieve me-from liability for any damage ! <br /> to persons or property caused by the use of" these pesticides. I waive any <br /> claim of liability for damages against the County Department of Agriculture <br /> based. on the issuance of this permit . I further understand that this permit I. <br /> may be revoked when paeticides are used in conflict with the manufacturer ' s <br /> labeling or in .violation of applicable laws, regulations and specific <br /> conditions of this permit . I authorize inspection at all reasonable times and <br /> whenever an emergency exists, by the Department of Pesticide Regulation or the <br /> County Department of Agriculture of all areas treated or to be treated, storage <br /> facilities for pesticides or emptied Containers and equipment used or to be used <br /> in the treatment .,;3. Form PR-ENF-125 Rev. 07/92 gestic ,� <br /> ( ide fo_ <br /> ( ) cement Branch <br /> Permit Applicant ,. J f"tldf{ �,r 1rliF1 ti a � Sign . <br /> Title : f � -� Issue Dat . <br /> Issuing Officer : Y Issue Date: 0 <br /> I <br />
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