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04/25/05 01:' "' P.003 <br /> 12/03/2004 13:58 20940. 33 FIFTH FLDDR PACE 01 <br /> I San Joaquin • <br /> 1� Environmental Health Department <br /> 304 E Weber Avenue FAX#: (208) 468-3433 <br /> 3b Floor, Stockton, CA 95202 <br /> Phone; (209)468-3420 <br /> =FAX DATE: December 3, 2004 TIME: 12:55:29 PM <br /> #of Pages (including this sheet): I 2 I <br /> TO: Mike Berghold FAX: 333-1666 I�_1 <br /> OF: Berghotd Winery <br /> FROM: Adrienne Ellsaesser Lead Sr. R.E.H.S. VOICE PHONE: (209)46&0343 <br /> RE: Small Public Water System <br /> O Urgent C For Review 0 Please Reply O Please Recycle <br /> Comments: <br /> Per our phone conversation: <br /> Attached you will find a Water System Declaration Form. Please fill out form, sign and fax It <br /> back to me. I will call you to let you know if you are operating as a Pubic Water System. <br /> Call if you have any questions. <br /> Thank you, <br /> Adrienne G 3 <br /> AGC) <br /> STAYEMV4T OF CONRD134TIALITY• Th.trrbn %OR In V.s famrle is I¢ppNy}'prM.*Dsd daanrda"l Inrarrnslgninfanded o*far did usedd eddMesdo <br /> lefad ai iht cowrehert Irrhe T 406(0,.n.OMM Is M rhe.inl ded mr-am.a Ire veybyee Wag"f S"U ble W sen...II W Na Reond.d re o"t, <br /> pu we herob wblwa m.I.ny dlsafhinatl.n.diwitka d an aaprrq of/Ml faldeaCl'u smy mhibaed. N)Ka nsA reeaMd dse feus R*e in an X.,please <br /> hrvllWbMy IIDfd"=-%==1 <br /> MMedrune ai rheM Asr Nfled arl 0h%m ,sheet and talon In,o jo.i a oae.mus ai T..b edUmw Nd unit�d3 ..Ws <br /> SeMce. We.Fd rei -%va.saW 1n. MPN..and reu 4rhem .Wmue. tT hYw. <br /> EH134&CH-0/2 FAX COVER SHEET <br /> REVI9t11fif4-7l <br />