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It <br />�j <br />"OF' <br />SAN JUIN COUNTY PUBLIC HEALTOERVICES <br />P 0 Box STocKwN, CA 95201-0388 9 Mow (209) 468-3420 <br />ERNEST M. FUJIMOTO, M.D., M.P.H., ACTING HEALTH OFFICER <br />DONNA RERAN, R.E.H.S., DIRECTOR, ENVIRONMENTAL HEALTH DIVISION <br />ENVIRONMENTAL HEALTH <br />PERMIT TO OPERATE #0056,33 for PR4-S0109 <br />4522 TE CARE FACILITY HE-ALTH PERMIT <br />Yalid from 01/01/97 t.a 12/31/97 <br />41, PERMITS - TO' OPERATE and ANNUAL PERMIT FEE PAYMENTS are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br />Those referenced above are Valid ONLY for <br />OWNER NAME: ST JOSEPHS MEDICAL CENTER CORP <br />DBA; ST DOM INIQUES HC*3PITAL <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /># + # + # + * # + # <br />10`:PITAL r <br />1 <br />REGULATED FACILITY; ST DOMTf4N :� _; <br />1777 W`YOSEMITE AVE <br />MANTEL A�; CA 9-5:33ES <br />BIL' IR -46 AM, SS! <br />DOMIN S H01 -*P T TAII <br />ATTN: ST DOM INIC'S ACCT PAYABLE <br />1"7 -/ 7 W Yl-;,:;FMTTE AVE <br />IIANTI <br />I =CA, CA 9S336 <br />Facility ilii 000998 <br />Account ID! 000099S <br />Permit Issued., 0:J/ 10 /9"� <br />I <br />