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FIELD DOCUMENTS_CASE 1
Environmental Health - Public
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EHD Program Facility Records by Street Name
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MARIPOSA
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13521
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3500 - Local Oversight Program
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PR0545534
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FIELD DOCUMENTS_CASE 1
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Last modified
3/13/2020 2:05:47 AM
Creation date
3/12/2020 11:53:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
CASE 1
RECORD_ID
PR0545534
PE
3528
FACILITY_ID
FA0001457
FACILITY_NAME
COLLEGEVILLE MARKET & CAFE
STREET_NUMBER
13521
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
18306007
CURRENT_STATUS
02
SITE_LOCATION
13521 E MARIPOSA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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y._ <br /> '� r•�:r Cutbenson, reef. ( <br /> ,/t.JUNUU")l LUUAL HEAL 11.1 Ut, MC:T <br /> � <br /> ralrkla E. Vannuccl, Sec'.y, SEAVINO <br /> Anthonelle Van Spron,en 1601 East Hazellon Avenue. P. O. Box 2009 San Joe Clty of Lodi <br /> Earl rlmentel quin County <br /> Fern Oupbee <br /> Stockton. Callfornia 95201 City of Efcelon <br /> Daniel L. Flores209/466-67$1 City of Manteca <br /> John D. Mail. M.O. City of Ripon <br /> William J. Wads Cltyof Stockton <br /> Jopl Khanna. M.O., M.P.H.. District Neallh Officer City of Trace <br /> Mary Anna Lova Son Joaquin County <br /> Son Joaquin County <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1, the undersigned owner and/or operator of the property and/or -facility <br /> located at ac�ltty <br /> hereby authorize <br /> l /lam GSa�r/ <br /> to release any and all analytical results. geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon- <br /> as it is available and at the same time it is provided to Ina or my <br /> representative. <br /> Owned/Operator: <br /> Address _ p Title: �4M4_dA <br /> —Phone: Qal <br /> Date: <br /> ( Ii 08 US U(;T.., 13 <br />
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