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REMOVAL_2006
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PR0231441
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REMOVAL_2006
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Entry Properties
Last modified
8/9/2022 2:10:22 PM
Creation date
11/8/2018 9:41:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2006
RECORD_ID
PR0231441
PE
2361
FACILITY_ID
FA0003604
FACILITY_NAME
BEACON STATION #3492*
STREET_NUMBER
470
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
22307101
CURRENT_STATUS
02
SITE_LOCATION
470 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Supplemental fields
FilePath
\MIGRATIONS3\M\MAIN\470\PR0231441\REMOVAL 2006.PDF
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EHD - Public
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• <br />i <br />POLICYHOLDER COPY WE <br />STATE PO BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />INSURANCE <br />FUND cERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE! 06-02-2000 GROUP: 00060/ <br />POLICY NUMBER: 0000160-2008 <br />CERTIFICATE ID: 15 <br />GEnTIFIGATF FXrIRE6:68-01-2007 <br />05-01-2008105-01-5007 <br />ARTHIR J. BALLAO[R NE <br />7010 N INp1Aia AVE STE 201 <br />FRESNO CA 09711-6850 <br />This Is to certify that we have issued a valid Workers' Compensation insurance Policy in a form approved by the <br />California Insurance Commissions to the employer named below for the policy period inr6csted <br />This policy Is not Subject to carimliebo , by the Fund eXcapt coonalo days advance wrhten notice to the employer. <br />We will also give You 00doys advance nonce should this policy be cancelled prior to its normal expiration. <br />This cerifficate of inywance is not on Insurance policy mid does not amend, extend or altar the coverage afforded <br />by the policy listed herein. Notwdhstandin0 any requirement, term or condition of any contract or other document <br />with respect to which this cartit"a of Ineprance may be tSsued of TO Nmlcn it may pertain, ins Insurance <br />afforded by the policy described herein to Subject to all the terms, excivalons, and conditions, of such policy. <br />tMICRIZE0REPRESENTATI PRESIDENT <br />EIpLO►ER•S LIABILITY LIMIT Iammisi OEFIIISE COSTS: $1,000,000 PER OCGIIDtENCE. <br />IBiOMENE1R /1fI00 - CARAI! PBCPLU PM MIOENT - EZCL 1010, <br />EfODRSE71EW /1000 - CIMS PEOPLES CFO SECRETARY - EXCLOOED. <br />Ali FORMS ABT DF S <br />MMAOII9 NI 0"M EMITILED FI E MLOOEM' WrICE EFPECFIVE 07 0! -et-20IS <br />EMPLOYER <br />REMEDIATION RISK MANAIIEMENI INC ORA' TRITON <br />COMTM=zoN <br />2580 SOGUEL AVE STE 202 <br />SANTA CIM CA 00082 <br />1P/6,NE1 <br />PRIIfIED ' 05-05-2008 <br />Arv2.09) <br />
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