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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 /> ANNUAL OPERATING FEE PAID- PE 4621 - SMALL COMMUNITY PUBLIC WATER SYSTEM <br /> Permit ID# PT0026678 for Record ID# PR0543080 <br /> Valid From 7/1/2023 To 6/30/2024 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: HAYNES, RONALD E <br /> DBA: HAYNES BOARD &CARE HOME <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: HAYNES BOARD & CARE HOME Facility ID FA0004405 <br /> 17201 N TULLY RD Account ID AR0004087 <br /> LODI CA 95240 Issued 5/30/2023 <br /> Billing Address: ATTN : RONALD HAYNES <br /> HAYNES BOARD & CARE HOME <br /> 17201 N TULLY RD <br /> LODI CA 95240 <br /> 7027.rpt End of Report <br />