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r i rY-$ r•d� i. c r' . ,ar ,r t <br /> SAN JOAQUI BOUNTY ENVIRONMENTAL HEALTH PARTMENT <br /> r <br /> 1868 E.Hazelton Ave. • Stockton,CA 95205-6232 • Phone(209) 468-3420 <br /> Donna Heran,R.E.H.S.,Director <br /> ENVIRONMENTAL HEALTH <br /> a.ir. ,y.,^, - <br /> h <br /> {,aro 3£ <br /> PERMIT TO OPERATE 4524 SKILLED NURSING FACILITY <br /> 7 . <br /> �. � ,� Y�V���n mr.� xy Y"'r a,• �n f*ty.:.P r4 .k�„ an -R��T,a � ",amu. � .��'O!.:'�. �6�,r,,�" �e,, y�7.,'� -.. '}:�t� � !€k h r'��� �Y4�� <br /> s� Permit ID#PT0022157 for Record ID#PR0536162 � <br /> I <br /> Valid From 1/1/2014 To 12/31/2014 <br /> X <br /> � � r <br /> ar R � 4v <br /> `,�°�t;�'Ma x.;. <br /> ab4 q'. <br /> t t } <br /> h a r a *',"stta x r{.. ,.fir: s3„ #{' .;d r .>r{` r c< ..r a. t .k <br /> Y 4{ r y r c errs 7� t _ } n ' <br /> 4 r x "# a / P .0. 4 r't d""= / r a <br /> NY y Via' <br /> Z <br /> � <br /> £'k i `4. �` "a�+ a <br /> .r <br /> Y <br /> 16 <br /> r� ri <br /> {t�r3 <br /> ° `7e } x° x <br /> - {+ <br /> ,.ss A• i r { r t'�'� Y '`,rtr.., * { <br /> s x <br /> s. a •t r 4. r.,§ x > r r �' 's <br /> �' <br /> p <br /> P7 <br /> ` PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for COVENANT CARE LODI LLC <br /> m r• 4 5'Y ex i r - $ Y i t s a <br /> ,x ,t�,� <br /> f� U` ', j@yv �.T {4 <br /> 4Y-` <br /> r <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Facility ID FA0009105 <br /> Regulated Facility: COVENANT CARE LODI LLC " r <br /> q Account ID AR0016105 <br /> 900 N CHURCH ST Issued 11/22/2013 <br /> 9{ <br /> LODI CA 95240 z4 # " <br /> x� r x <br /> ` <br /> a <br /> Billing Address COVENANT CARE LODI LLC i <br /> 900 N CHURCH ST �� x��' <br /> LODI CA 95240xr <br /> Jr <br />