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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545283
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
2/3/2020 12:33:45 PM
Creation date
2/3/2020 11:40:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545283
PE
3528
FACILITY_ID
FA0004712
FACILITY_NAME
WILLIAM BURKHARDT
STREET_NUMBER
5154
STREET_NAME
HOGAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06112001
CURRENT_STATUS
02
SITE_LOCATION
5154 HOGAN LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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1 , P�293 132 120 , <br /> 1' Receipt for <br /> Certified Mail <br /> No Insurance Coverage Provided <br /> Do not use for International Mail <br /> � <br /> , .,rart. (See Reverse) <br /> Sentto <br /> Surat and No. <br /> P.D., tare and ZIP Code <br /> ostege $ . 32 1 <br /> I� <br /> Certified Fee 1 .10 <br /> Special Delivery Fee I` <br /> Restricted Deliver'Fee <br /> Return Receipt Showing 1 106 <br /> 7 to Whom&Date Delivered <br /> Return Receipt Showing to Whom, <br /> Date,and Addressee's Address <br /> TOTAL Postage <br /> ® &Fees <br /> 0 Postmark or Date <br /> M <br /> E <br /> o <br /> 3 LL <br /> N <br /> m SENDER- 1 a �...�+�. • �r ish to receive the , K <br /> 9 • Complete items 1 andlof'2 Yor'edAitfdllsT s216i£23. m <br /> m following services (for an extra <br /> • Complete items 3,and 4e&b. feel: <br /> 0 t{�rint.your name and address on the reverse of this form so that we can <br /> d burn this card to you. 1. ❑ Addressee's Address y <br /> • Attach this form to the front of the mailpiece,or on the beck if space <br /> m a <br /> dons not Return 2, ❑ Restricted Delivery m <br /> L .,,Write"Return Receipt Requested"on the mailpiece below the article number. 0 <br /> I.' The Return Receipt will show to whom the article was delivered and the date Consult postmaster for fee. 0 . <br /> deriyered. 41. Article Number <br /> 1 m 3. Article Addressed to: P 293 132 120 ' <br /> d WILLIAM BURKHARDT qb. Service Type ¢ <br /> ° 5154 HOGAN LANE Insured <br /> E ❑ Registered ❑ <br /> 0 LODI CA 95240 ❑ COD <br /> Certified <br /> ra Express Mail ❑ Return Receipt for <br /> N Merchandise j <br /> 7. Date of Delivery 0 <br /> }} Q7 <br /> yfQ > <br /> y 5. S n�iure (Addresse 8. Addr s de's Address (Only if requested ac I <br /> I andto is paid) z <br /> 6. Signature (Agen 1 ,x•'wi ' <br /> > PS Form 3811, December 1991 AU.S.OP0:1ee3-a62-� 4 DOMESTIC RETURN RECEIPT <br /> N <br /> L� <br />
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