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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave•Stockton,CA 95205-6232•Phone(209)468-3420 <br /> Jasjit Kang,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> PERMIT TO OPERATE - PE 1626-RESTAURANT/BAR 101 +SEATS <br /> Permit ID# PT0008484 for Record ID # PR0505996 <br /> Valid From 10/1/2021 To 9/30/2022 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: CALIFORNIA RESTAURANT CONCEPTS INC <br /> DBA: BLACK BEAR DINER- LODI <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: BLACK BEAR DINER- LODI Facility ID FA0007134 <br /> 2347 W KETTLEMAN LN Account ID AR0010334 <br /> LODI, CA 95242 Issued 8/17/2021 <br /> Billing Address: ATTN : BENEPAL, BURT <br /> BLACK BEAR DINER- LODI <br /> 365 SILAS CT <br /> BENICIA, CA 94510 <br /> combined.rpt End of report <br />