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SAt JOAQUINCC'lll 17V ENVIRONMENTAL HEALTH D AT ENT <br /> 1868 E.Hazelton Ave. • Stockton,CA 95'-7-05-6232 • Phone(209)468-3420 <br /> Donna Heran,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - 4520-PRIMARY CARE FACILITY <br /> Permit ID#PT00003,96 for Record ID#PR0450055 <br /> Valid From 1/1/2015 To 12/31/2015 <br /> r <br /> i? <br /> a ' <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> r PERMIT(s)Valid only for: Lodi Surgical Associates <br /> DBA: LODI OUTPATIENT SURGICAL CENTS <br /> a ' <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> + f"Y: Lodi Outpatient Surqical Center Facility 1° FA0000388 <br /> Account ID AR0000387 <br /> 521SHam LnF <br /> Lodi. CA 95242 issued 11121/2014 <br /> LODI OUTPATIENT SURGICAL CENTER <br /> $21 S NAM LANE <br /> Lodi CA 95242 <br /> M <br /> ,— <br />