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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545776
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/28/2020 4:51:36 PM
Creation date
5/28/2020 4:36:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545776
PE
3528
FACILITY_ID
FA0002231
FACILITY_NAME
JACK FROST ICE SERVICE
STREET_NUMBER
425
Direction
N
STREET_NAME
UNION
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15112003
CURRENT_STATUS
02
SITE_LOCATION
425 N UNION ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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i<h\ <br /> • � i amt �* � <br /> r <br /> • COMPLETE SECTION / DELIVERY <br /> SESE <br /> NDER: <br /> ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Deiivery <br /> item 4 if Restricted Delivery is desired. <br /> ■ Print your name and address on the reverse C. Si nature <br /> so that we can return the card to you. ❑Agent <br /> ■ Atta�ArWt*ck of the mail jepe, )( r ❑Addressee <br /> C oro r t s ermits. UCJI �V <br /> D. Is delivery address different from item 1? ❑Yes <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑ No <br /> Cn <br /> lti aR u1 I <br /> fl �a I 4 YNE AND SUSAN HENRY <br /> 40 p iR 99 P a BOX 843 3. Se ice Type <br /> V I CA 95353 <br /> '� �� � � E MODESTO �ertitied Maio ❑ Express Mail <br /> cc ?` m ❑ Registered El Return Receipt for Merchandise <br /> " ❑ Insured Mailru <br /> ❑C.O.D. <br /> ti <br /> 'm w U PR c 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> N O. O O o co 2. Article Number(Copy from service label) <br /> L C c in � yam" F a l <br /> ISrn a° N Cr ¢ PS Form 3811,July,1999 Domestic eturn Receipt 102595-00-M-0952 <br /> Q z a 9664 111dV`OO8E�Od Sd + r�� <br /> 11 <br /> all • COMPLETE <br /> ■ Complete items 1,2,and 3.Also cam fete SECTIO • DELIVER <br /> item 4 if Restricted Delivery is desired p A. Received by(Please Print Clear! <br /> ■ Print your name and address on the reverse y Date of Deli <br /> SO that we can return the card to you. C. Signature <br /> Q ■ or on t thio' t the mailplece, <br /> G or on the s�1 J,�y i`_ b X Agent <br /> tT T. Article Addressed to: D. Is delivery address different from item 1? L] yes <br /> sressee <br /> If YES,enter delivery address below; ❑No <br /> Lr) d 4 <br /> y U s9 <br /> a N UNI0N ICE LTD <br /> ca V $ 6100 SHEILA ST <br /> ' a 0 LOS ANG 3. Se ice Type <br /> w ANGELES <br /> l P. <br /> � m%— H C9 9 Z p� o CA 90040 Certified Mail ❑Express Mail <br /> CISf 4 N _L9 °�' •4 p a 'fit � Y Registered <br /> El <br /> ❑crP. <br /> ,�, NO" <br /> . ftCceiFtiur Iviercnandise flp <br /> ❑Insured Mail ❑C.O•D.0 .4g? Xi 4. Restricted Delivery?(Extra Fee)CL '5 cls aT a 2. Article Number(Copy from service label) ❑Yes <br /> z 9664 I!adV'DO$£uuod Sd �- L . <br /> PS Form 381 ,July 1999 <br /> Lrf�� D�m tic Ret rn ec pt <br /> y <br /> �� :E �I7i 102595-00-M-0952 <br />
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