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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0522218
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/9/2024 2:00:20 PM
Creation date
12/18/2023 11:43:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0522218
PE
1615
FACILITY_ID
FA0015144
FACILITY_NAME
SUTTER MARKET
STREET_NUMBER
632
Direction
N
STREET_NAME
SUTTER
STREET_TYPE
ST
City
STOCKTON
Zip
95202
CURRENT_STATUS
01
SITE_LOCATION
632 N SUTTER ST
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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SAN .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST PAZ 022 <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> JA (At ,Mc�, ( Sl—H- 5"RCDOS-1459 <br /> OWNER/OPERATOR <br /> CHECK If BILLING ADDRESS❑ <br /> FACILITY NAME <br /> ( <br /> SITE ADDRESS <br /> Street Number Direction Street Name City Zip Code <br /> HOME or MAILING ADDRESS (If Different from Site Address) <br /> O1 a 0.o nL\ t' Street Number Street Name <br /> CITY S AT,E ZIP n <br /> Y\ /ITS O' <br /> PHONE#1 EXT. APN# LAND USE APPLICATION# <br /> (goy) $tib = 1)3-.57 <br /> PHONE#2 EXT. EMAIL BOS DISTRICT LOCATION CODE <br /> ( ) <br /> CONTRACTOR / SERVICE REQUESTOR <br /> REQUESTOR <br /> CHECK If BILLING ADDRESS <br /> �L <br /> BUSINESS NME PHONE# EXT. <br /> u}�.e r chid '1 l� <br /> HOME or MAILING ADDRESS FAX# <br /> (A vqtl v ( ) <br /> CITY h UA <br /> h SAE IP EMAIL <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity <br /> will be billed to me or my business as identified on this form. <br /> also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN <br /> COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws. <br /> APPLICANT'S SIGNATURE:— DATE: <br /> PROPERTY/BUSINESS OWNER 'OPERATOR/MANAGER ❑ OTHER AUTHORIZED AGENT ❑ <br /> If APPLICANT is not the BILLING PARTY,proof of authorization to sign is required Title <br /> AUTHORIZATION TO RELEASE INFORMATION:When applicable, I,the owner or operator of the property located at the above site <br /> address, hereby authorize the release of any and all results,geotechnical data and/or environmental/site assessment in ation to the <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as It IS available and at the same time It IS provid <br /> representative. R <br /> TYPE OF SERVICE REQUESTED: G+ i/4,+ Ykk,r <br /> COMMENTS: <br /> ?023 <br /> 'r #qtr <br /> ACCEPTED BY: C`� f� S O EMPLOYEE#: DATE: 11-2—;K-2-3 <br /> ASSIGNED TO: ✓ EMPLOYEE#: DATE: <br /> Date Service Completed (if already completed): SERVICE CODE: PIE: <br /> Fee Amount: (p — Amount Paid I Payment Date <br /> Payment Type l; Invoice# l l 2�j�} Received By: <br /> EHD 48-02-025 SR FORM(Golden Rod) <br /> 03/22/23 <br /> 5 <br />
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