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1868 E.Hazelton Ave. •Stockton, CA 95205-6232 •Phone (209)468-3420 <br />Jasjit Kang, R.E.H.S., Director <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENTAL HEALTH <br />ANNUAL OPERATING FEE PAID - PE 4634 - TRANSIENT-NONCOMMUNITY PUBLIC WATER SYSTEM <br />Permit ID # PT0026793 for Record ID # PR0543317 <br />Valid From 7/1/2021 To 6/30/2022 <br />PERMITS TO OPERATE are NOT TRANSFERABLE <br />and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s) Valid only for: <br />THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br />LODI LODGE NO 634 <br />Regulated Facility: <br />3824 E WOODBRIDGE RD <br />ACAMPO CA 95220--946 <br />Facility ID <br />Account ID <br />Issued <br />FA0019077 <br />AR0033968 <br />6/11/2021 <br />MOOSE OUTDOOR SPORTSMAN CLUB <br />ATTN : ADMINISTRATORBilling Address: <br />MOOSE OUTDOOR SPORTSMAN CLUB <br />3824 E WOODBRIDGE RD <br />ACAMPO CA 95220--946 <br />7027.rpt End of Report