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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 E.Hazelton Ave•Stockton,CA 95205-6232•Phone(209)468-3420 <br /> Jasjit Kang,R.E.H.S.,Director <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 7/1/2023 To 6/30/2024 <br /> PERMITS TO OPERATE are NOT TRANSFERABLE <br /> and may be SUSPENDED or REVOKED for cause. <br /> PERMIT(s)Valid only for: LODI LODGE NO 634 <br /> THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES <br /> Regulated Facility: MOOSE OUTDOOR SPORTSMAN CLUB Facility ID FA0019077 <br /> 3824 E WOODBRIDGE RD Account ID AR0033968 <br /> ACAMPO CA 95220--946 Issued 5/25/2023 <br /> Billing Address: ATTN : ADMINISTRATOR <br /> MOOSE OUTDOOR SPORTSMAN CLUB <br /> 3824 E WOODBRIDGE RD <br /> ACAMPO CA 95220-9469 <br /> 7027.rpt End of Report <br />