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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0523611
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
2/12/2019 9:51:00 AM
Creation date
2/12/2019 9:43:44 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0523611
PE
2950
FACILITY_ID
FA0015939
FACILITY_NAME
VALLEY WATER TREATMENT
STREET_NUMBER
612
Direction
N
STREET_NAME
BUENA VISTA
City
STOCKTON
Zip
95203
CURRENT_STATUS
01
SITE_LOCATION
612 N BUENA VISTA
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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Title: Executive Officer <br /> Date: TY-139 <br /> Or v✓� <br /> STATE OF ) Acknowledgment as to Covenantor <br /> f ) <br /> COUNTY OF Wc4 sk l 6n) <br /> rd , <br /> On c� �, 3 , 20o tt before me, ayICy _ <br /> the undersigned personally appeared <br /> personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) <br /> whose name(s) is/are subscribed to the within instrument and acknowledged to me that <br /> he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their <br /> signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) <br /> acted, executed the instrument. <br /> WITNESS my hand and official seal. <br /> California All-Purpose <br /> Acknowledgment Attached <br /> o ary Public in and for said <br /> County and State �Gs1 t fl p1 pFFIC1AL SEAL <br /> vt v�b I r j V o MDNAD M 3HARMA <br /> NOTARY PUBLIC-OREGON <br /> COMMISSION N0. 434061 <br /> NPI COMMISSION EXPIRES Nov 6.2012 <br /> STATE OF CALIFORNIA ) Acknowledgment as to California Regional Water <br /> Quality Control Board, Central Valley Region <br /> COUNTY OF SFSC)?_fW,-X170 ) <br /> On TA N a A R 4 ' , 20(before me, 7�FA N ti iE_ PJ S Lk M FI"r—r <br /> the undersigned personally appeared c.ceu-mN, personally known to me or proved to me on the <br /> basis of satisfactory evidence to be the person whose name is subscribed to the within instrument <br /> and acknowledged to me that he executed the same in his authorized capacity as Executive <br /> Officer, and that by his signature on the instrument the California Regional Water Quality <br /> Control Board, Los Angeles Region executed the instrument. <br /> 6 <br /> DOCSS V I-55004.1/valley_waler_decl.apprvdbyboard[1] <br />
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