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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545283
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/3/2020 12:33:45 PM
Creation date
2/3/2020 11:40:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545283
PE
3528
FACILITY_ID
FA0004712
FACILITY_NAME
WILLIAM BURKHARDT
STREET_NUMBER
5154
STREET_NAME
HOGAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06112001
CURRENT_STATUS
02
SITE_LOCATION
5154 HOGAN LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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00030 �g8 <br /> Z 187 935 644 <br /> US.PostalService ., .__� _- _ <br /> ATTN MARK LIST <br /> CENTRAL VALLEY REGIONAL <br /> WATER QUALITY CONTROL BOARD <br /> UNDERGROUND STORAGE TANK UNIT <br /> 3443 ROUTIER RD STE A <br /> SACRAMENTO CA 95827-3098 <br /> wa. W <br /> certified Fee <br /> Special Delivery Fee <br /> Restricted Delivery Fee <br /> N <br /> m Retum Receipt Showin to <br /> Whom 8 Date Delivere <br /> CL Rehm Receipt Slnwng it Whom. <br /> Q Date,&Addressee's Address <br /> 0 TOTAL Postage&Fees $ <br /> � <br /> Postmark or Date <br /> LL / s <br /> a <br /> SENDE <br /> 'o •Complet ems 1 anNo or additional serdces. so I receive the <br /> t <br /> n •Complet items 3,4a,and 4b. following services(for an <br /> •Print your name and address on the reverse of this form eo that we can return this <br /> Attacard ch this <br /> •Atlach this form to the front of the mailpiece,or on the back if space does not J�tTJ ICLJ <br /> permit. d re Address <br /> y •Write'Retum Receipt Requested'on the mailpiece below the article number. 2. El Restricted Delivery y <br /> :Write <br /> Return Receipt will show to whom the article was delivered and the date <br /> c delivered. Consult postmaster for fee. a <br /> ATTN MARK LIST 4a.Art cle_Numbar <br /> a CENTRAL VALLEY REGIONAL <br /> c WATER QUALITY CONTROL BOARD 4b.Service Type <br /> UNDERGROUND STORAGE TANK UNIT t❑ Registered Certified ¢ <br /> 3443 ROUTIER RD STE A ❑ Express MailInsured OI <br /> SACRAMENTO CA 95827-3098 �❑ ReturnReceipt for Merchandise ElCOD <br /> 7.Da a of D ]itragr <br /> a cU! Q o <br /> C y o <br /> ¢ a <br /> 5. Received By:(Print Name) 8.Address a's A ess(Onlyi/regtiested X- <br /> ¢ and fee is pai r <br /> 6.Signature (Addressee or Agent) <br /> F <br /> T X <br /> 0 <br /> PS Form 3811, December 1994 Do stic Return Receipt <br />
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