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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 />PERMIT TO OPERATE - PE 1632 EXEMPT FOOD <br />Permit ID # PT0003106 for Record ID # PR0163211 <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 />DBA: <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />HSA-AGING & COMMUNITY SERVICES <br />Regulated Facility: <br />11157 W LARCH RD <br />TRACY, CA 95376 <br />Facility ID <br />Account ID <br />Issued <br />FA0003115 <br />AR0002678 <br />6/9/2021 <br />LARCH CLOVER CENTER <br />BOYETTE, ERTE'ATTN : Billing Address: <br />LARCH CLOVER CENTER <br />PO BOX 201056 <br />STOCKTON, CA 95202 <br />End of report7024.rpt