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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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3049
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3500 - Local Oversight Program
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PR0545717
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
11/19/2024 3:47:36 PM
Creation date
6/3/2020 11:12:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545717
PE
3528
FACILITY_ID
FA0003912
FACILITY_NAME
MARTINIS BAIT & TACKLE
STREET_NUMBER
3049
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
APN
02514016
CURRENT_STATUS
02
SITE_LOCATION
3049 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
LSauers
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EHD - Public
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+ SAN JOAOl1IN COATY - PU$L1C IDEAL NTA f HEALTH D1YiS3�1., „ <br /> S1tE IMFORMATION HER LEAD AGENCY <br /> ITE NAME AGflICY.I CONTACT i t <br /> Idlewild Market 41 <br /> PHONE <br /> DRESS 3049 W . Highway 12 APO # i ! <br /> i <br /> ITTLodi IP 95242 . <br /> AKE Oil Equipme.nht Service. <br /> WAILING ADDRESS P . O . BOX 950 <br /> ITT San Andreas', TATE s'CA Ip 95249 <br /> TACT'NAMEKeith A . Tallia Ha+E 209-754,-1808 " <br /> ORCPERTY OWMER/OPERATOR <br /> AME Surendra F .;I Patel 209-368 ' 1152 <br /> DRESS 607 So . Cherokee <br /> ITT Lodi AtZ: CA Ip ;E95240 <br /> CLIENT INFORMATION CIF DIFFERENT FROM OWNER/OPERATOR) ' . <br /> NONE i� <br /> AME <br /> ITT ATE I IP <br /> !, THE UNDERSIGNED OPERATOR. CLIENT, DR AGENT OF SAME; OF THE PROPERTY 'LOCATED AT;THE ABOVE SITE°ADORES$ HEREBY <br /> J <br /> F ANY AND ALL ANALYTICAL RESULTS, 090TECUICAL DATA AND/OR-ENVIROMKENTAL/SITE ASSESSHENT.,INFORNATION TO <br /> JAN. JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILA$LE.Am AT THE -SANE TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> ADDITIONALLY, I, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, .CR�ACSHT OF SAME. ACICNO RmGa THAT ALL Sin ANO/OR PROJECT SPECIFIC <br /> PHS/EHO HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL.BE <br /> AME Keith Tall -'a " - 5701'136-6792 <br /> I GNATURd:�� LATE 11/ 2/93 <br /> PANT Oil E ui meInt Service ITIS President : err <br /> 49-007CIV)12/9081LFRN12 <br /> EH 29 01 <br />
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