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Y Y nr.r•- � ENVIRONA#ENTAL HEAL W �I d (Applicable itern marker p ) NOTICE OF CANCELAVidWRIIVQEN RENEWAL _ CALIFORNIA CANCEL- a You are hereby notified in accordance with the lerms33 clfA�Fitie t of p Icy mentioned below that your insurance will cease LATtON at and from the hour and date mentioned below. Ji�L. f.pp r/i- 11 the -15?,. premium has been paid, premium adjustment will be made as soon as practicable after cancellationet:omes effective. I' If the premium has not been paid, a bill for the premium earned to the time of cancellation wilt be forwarded in due course. ❑ You are hereby advised that California law provides that upon request in writing made by you to this Company, such { request to be mailed or dellva►tid nest lana than 16 days prlof to the efltsdlive dattt Of you are enitllad to be informed by this Company in writing of the reason(s) for the cancellation. ❑ +The reason cancellation s written of thenamedinsured.ts heinsurer will rnifornia l furnish the facts on which the nsuranCode tion 676 ehereof) Upon cancellation based. 'Not applicable to Commercial Lines. These boxes will not be checked unless a California law is applicable. ❑ You are hereby notified in accordance with the terms and conditions of the policy mentioned below that,your insurance will cease at and from the hour and date mentioned below due to nonpayment of premium. i A bill for the premium earned to the time of cancellation will be forwarded in due course. NON- ❑ You are hereby notified in accordance with the terms and conditions of the policy mentioned below that the policy will expire t RENEWAL effective at and from the hour and date mentioned below and the policy will NOT be renewed. You are hereby advised that California law provides that upon request in writing made by you to this Company,such request to be mailed or delivered not later than one month following the effective date of the nonrenewal, the Company will notify you in wriiing of the reasoni3for such nonrenewal within 20 days of receipt of your requesl, You are hereby notified in accordance with the terms and conditions of the policy mentioned below that the policy wilt expire effective at and from the haul And pitta nte7ltl�l11rr1 hipli%w grill I"" pailny Wit Ntb'f he ranowed. F CCP 19 21 67-01 REASON FOR CANCELLATION HENNINGS BROTHERS DRILLING COMPANY 10 ❑Rewritten by j Named 3525 PELANDALE AVENUE 20 ❑Agents Request (23) b Non-pay Agent I INSURED MODESTO, CA 95356 30 ❑Nan payment of S on policy- 33 olicy 33 ❑Non payment Finance Company ! 1 40 0 Non Report of Payroll/Auditable values to— on o on policy 60 ❑Insured's Request 60 ❑Policy not accepted 70 ❑Company Election 90 ❑Policy issued in error KIND OF POLICY COMMERCIAL POLICY NUM ER EFFECTIVE DATE OF CANCELLATION OR TERMINATION N.P. R.W. A.R. C.E. } C P 19 21 97—m -08� 05-93 i r ®al 12:01 A.M. ❑at Noon Standard Time O { Policy _TSM INSURANCE AGENTS & BROKERS !1 Issued 13.17 OAKDALE ROAD, SUITE 910- i (Arent) (Agent) MODESTO, CA 95355-3369 GOLDEN EAGLE INSURANCE COMPANY t; SAN DIEGO,CALIFORNIA { By 1f I. JULY 22,_ —. 19-23 DATE MAILED F SAN DIEGO, CA MAILED FROM ALL PARTIES AS LISTED IN FILE Mortgagee r or Loss RECEIVING NOTICE !'33 Payable l L _.J CCP 19 21 67-01 F -93 SAN JOAQUIN HEALTH DEPT Mortgagee P 0 BX 2009 or Loss Payable STOCKTON CA 95201 LI IMPORTANT INFORMATION ON REVERSE SIDE