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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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h;LU L' <br /> V R�:yj CB v <br /> CALIFORNIA ALL-PURPOSE ACKNOWLEDGEM ffB ` � Ari 9'- <br /> File <br /> 'File No: 8702-224261TS(ts) <br /> STATE OF California )SS APN No: 135-080-03 <br /> COUNTY OF ro ) <br /> On 30,Kii rbefore me, 1Y&Jrj If �• S(�M Fg�T Notary Public, personally appeared <br /> who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within <br /> instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by <br /> his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,.executed the <br /> instrument. <br /> I certify under PENALTY OF PERJURY under the laws of the State of Califomla that the foregoing paragraph is true and correct. <br /> WITNESS m d and official seal. <br /> JEANNIE 8.SUMAIT <br /> Signature Commisslon N 1657774 <br /> 16t <br /> Notary K"lc-Califomia t <br /> Sacramento County <br /> N+y Comm.E)0m Apr 11,2010 <br /> This area for official notarial seal. <br /> OPTIONAL SECTION <br /> CAPACITY CLAIMED BY SIGNER <br /> Though statute does not require the Notary to fill in the data below,doing so may prove invaluable to persons relying on the <br /> documents. <br /> ❑ INDIVIDUAL <br /> ❑ CORPORATE OFFICER(S) TITLE(S) <br /> F-1PARTNER(S) ❑ LIMITED GENERAL <br /> ❑] ATTORNEY-IN-FACT <br /> ❑ TRUSTEE(S) <br /> ❑ GUARDIAN/CONSERVATOR <br /> ❑ OTHER <br /> SIGNER IS REPRESENTING: <br /> Name of Person or Entity Name of Person or Entity <br /> OPTIONAL SECTION <br /> Though the data requested here is not required by law, it could prevent fraudulent reattachment of this form. <br /> THIS CERTIFICATE MUST BE ATTACHED TO THE DOCUMENT DESCRIBED BELOW <br /> TITLE OR TYPE OF DOCUMENT: f}N I ffiAO ` i"MF T 2G5-ir21 L7'I O N �� <br /> NUMBER OF PAGES Q DATE OF DOCUMENT <br /> SIGNERS) OTHER THAN NAMED ABOVE <br /> - _ Reproduced by 11/2007 <br />
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