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1868 E.Hazelton Ave. •Stockton, CA 95205-6232 •Phone (209)468-3420 <br />Jasjit Kang, R.E.H.S., Director <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENTAL HEALTH <br />ANNUAL OPERATING FEE PAID - PE 4634 - TRANSIENT-NONCOMMUNITY PUBLIC WATER SYSTEM <br />Permit ID # PT0026511 for Record ID # PR0542685 <br />Valid From 7/1/2021 To 6/30/2022 <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s) Valid only for: <br />DBA: <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />LODI AIRPORT <br />KUPKA, ROBERT <br />Regulated Facility: <br />23955 N HWY 99 <br />ACAMPO CA 95220 <br />Facility ID <br />Account ID <br />Issued <br />FA0000003 <br />AR0000003 <br />6/24/2021 <br />LODI AIRPORT CAFE <br />ATTN : ROBERT KUPKABilling Address: <br />LODI AIRPORT CAFE <br />PO BOX 10 <br />ACAMPO CA 95220 <br />7027.rpt End of Report