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SITE INFORMATION AND CORRESPONDENCE_FILE 2
Environmental Health - Public
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EHD Program Facility Records by Street Name
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5491
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3500 - Local Oversight Program
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PR0545028
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SITE INFORMATION AND CORRESPONDENCE_FILE 2
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Last modified
12/6/2019 5:05:08 PM
Creation date
12/6/2019 2:55:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 2
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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r <br /> May 09 12 07:27a Jerry Moore 925m634-5408 p.2 <br /> y <br /> I <br /> i <br /> San Joaquin County <br /> Environmental Health Department <br /> 000 E. Main Street <br /> j Stockton, CA 95202 <br /> 3 <br /> Subject: CERTIFIED LIST OF RECORD FEE TITLE OWNERS FOR: <br /> SITE NAME: -- ------.---- <br /> i <br /> ADDRESS: �— <br /> 1 Complete#:1 ff there are multiple site landowners. <br /> Complete ##2 if you are the sole site landowner. <br /> I. In accordance with Section 25297.15(x)of Chapter 6.7 of the Health & Safety Code: <br /> Name of Primary or Active Responsible Party: <br /> certify that the following is a <br /> complete list of current record,fee title owners and their mailing addresses for the i <br /> above site: <br /> i I <br /> I <br /> i <br /> 2. In accordance nrith Section 25297.15fa) of Chapter 6.7 of the Health & Safety Code: <br /> frame of Responsible Party: i <br /> certify I am the sole landowner for the j <br /> above site:. <br /> Sincerely <br /> I <br /> uIC;IS[I LIf"F fat(: <br /> i <br /> Rc'risec 121`1S."- <br />
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