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1868 E.Hazelton Ave. •Stockton, CA 95205-6232 •Phone (209)468-3420 <br />Jasjit Kang, R.E.H.S., Director <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENTAL HEALTH <br />ANNUAL OPERATING FEE PAID - PE 4621 - SMALL COMMUNITY PUBLIC WATER SYSTEM <br />Permit ID # PT0026633 for Record ID # PR0542937 <br />Valid From 7/1/2021 To 6/30/2022 <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s) Valid only for: <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />HUFFMAN, MIKE <br />Regulated Facility: <br />19250 N LOWER SACRAMENTO RD # 16 <br />WOODBRIDGE CA 95258 <br />Facility ID <br />Account ID <br />Issued <br />FA0004216 <br />AR0006472 <br />5/27/2021 <br />MOKELUMNE MOBILE SENIOR PARK <br />ATTN : MIKE HUFFMANBilling Address: <br />MOKELUMNE MOBILE SENIOR PARK <br />19250 N LOWER SACRAMENTO RD SP 16 <br />WOODBRIDGE CA 95258 <br />7027.rpt End of Report