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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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12 (STATE ROUTE 12)
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13889
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3500 - Local Oversight Program
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PR0545719
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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 11:22:36 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545719
PE
3528
FACILITY_ID
FA0005335
FACILITY_NAME
CHARLES JACOBS
STREET_NUMBER
13889
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
13889 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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CE <br /> R <br /> December 15; 2009 RECENED <br /> Mr. Charles Jacob JAN 1 1 2410 <br /> P. O. Box 8820 <br /> Stockton, CA 95208 ENVIRONSERUICES H <br />�- PERM► I <br /> ( San Joaquin County Environmental Health Department <br /> ' 600 E. Main Street <br /> 4 Stockton, CA 95202 <br /> RE: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> + SITE NAME: Terminous Market <br /> 6 ADDRESS: 13889 W HM 12 Lodi CA 95242 <br /> j Complete #1 if there are multiple site landowners/record fee title owners. <br /> Complete #2 if you are the sole site landowner/record fee title owner. <br /> 1. In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: <br /> certify that the following is a <br /> complete list of current record fee title owners and their mailing addresses for the <br /> above site: <br /> { <br /> 2: In accordance with Section 25297.15(a) of Chapter 6.7 of the Health & Safety Code: <br /> Name ofn Responsible Party: <br /> certify-1,2m the soleaandowner-for the,�- -- -� <br /> above site. <br /> Sincerely, <br /> I � � <br /> Signature <br /> e , <br /> I <br /> s <br />
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