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<br /> 1868E Hazelton Ave. • Stockton, CA 95205-6232 • Phone(209)
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<br /> Donna Heran,R.E.H.S.,Director
<br /> 01, ENVIRONMENTAL HEALTH ,x Wry
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<br /> PERMITS TO OPERATE are NOT TRANSFERABLE
<br /> and may be SUSPENDED or REVOKED for cause.
<br /> PERMIT(s) Valid only for NGUYEN, QUAN b ,°
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<br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES
<br /> Regulated Facility: BELLA TERRA DENTAL f�,i i Facility ID FA0021255
<br /> : r Account ID AR0038423
<br /> 1110 W KETTLEMAN LN4 s
<br /> LODI CA 95240 `} "a�� issued 11/21/2014
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<br /> Billing Address: ATTN : NGUYEN, QUAN � � '
<br /> BELLA TERRA DENTALf
<br /> 702 PORTER AVE STE FRS f g � ?
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<br /> STOCKTON CA 95207 _
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