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FIELD DOCUMENTS FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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1403
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2900 - Site Mitigation Program
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PR0505513
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FIELD DOCUMENTS FILE 1
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Last modified
6/20/2019 3:36:17 PM
Creation date
6/20/2019 2:45:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0505513
PE
2950
FACILITY_ID
FA0006438
FACILITY_NAME
United # 5446
STREET_NUMBER
1403
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12323246
CURRENT_STATUS
02
SITE_LOCATION
1403 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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JAN 09 192 10:23 TONTC ?ILLING 916-9156-8835 <br /> SENT FY:TONTO DR I LL I Na 1- 9-9a 10:2;4RM : 714: ''307 7* * 9-915 966 <br /> CALIiORNIA-STATi ANIS t.{1N4umR A--'1664 r1M►"-' <br /> CONTRACTORS STATE LICENSE BOARD <br /> • ,' St a2 trdr�lsw Rao ,iw.�rr.,Cniltan�{e <br /> MOI*'wr.tu P.C.has 26000 <br /> tiacreewMo'Csillomim 94416 Office Use 0* <br /> • Fes No. <br /> dOSICE OF CHANGE OF NAME Olt ADDRESS form oifee_ — <br /> w►ark the nymbor of wpwr lir..No. <br /> OT�I tf yav with to erect either a new cuss!l <br /> ria•nM and/or a now met tilenw, nal cheek for the Class <br /> �uostesl in the loo,46a)below and ottoch a money orderl wntAW,cashier's ar r'�° Claes <br /> oppreprfate amount pelyable let Registrar of Canttsxton.f90 NOT!{fNfi CASH- ROW.�a,�.��P.C.^�- <br /> Theri cull/be a d 10.00,servfce Charge for each drshonofw 61. .ck, Chg,Not, <br /> DR1C3lNAL t1CC:N3i: CERTIltICAT! (Wall license) <br /> .CURRlNT RINEWAt GtlRTiFCCATL (Packet limns.) <br /> M be granted only if the !{Conte b currently renewed. tf th. cur. <br /> ay share It~no its <br /> M1ey lee ranted if the license is currently renewed or renewable rant o license is r•tvmed�for h�s�Padidttfenai copy <br /> 12.00 t'E PEA EACH COPY. for lice first copy. Enclose $2. <br /> reported to fhe ReplMrar of CeMtaatcrs wllhln 20 days af4st such Change Is made' at requirsd <br /> A change of address or name style must be rep an owner, partner, or an a#icer of a corporation. <br /> under Sectfork 7082 of the Contractors laterite Law.This form r{tust 0 Signed ht peMll nre not aecepbble•I <br /> (Pleo•e p►Int e►type Alf lnfor7natkn,/p►ms comp eu►eelrlcaneN� <br /> OM r'sa+awsr� <br /> G66 NAM&f"%X W RNOW14 Ox tAUSIO is 1 <br /> D e�tac 1?rS113=: �rvicet3 Ino• �,.„�,�.�o,,...t Ne..Mo Al1�A a..• <br /> CHANGfI OF ADORI SS-4ndivtdt►aI, Portnotyhip, Grper.tlen el* coos NO; <br /> FROM- <br /> 10— <br /> RO -' �rnee7 OR Box NWMa v1g1 <br /> CiCOUKfYi <br /> ltAT><r jD GOeT NOi <br /> 10— eT11Kl4 OR SPR NUMS, <br /> writ a0y� <br /> torte andel enalry of perJury under the 14+ws 60140 State or CaiUforrlia to the truth and occur w of the oboes stat•rnonts• <br /> 1 hereby � P <br /> Date Sygnah+te of Owner,Partner or Officer <br /> CHANo! OF NAM11.—lndlvldual of ►attnw+>wiP ansibi• <br /> be mads 1f tl+ers has bskn no change in personnel and if the name style does not indleatt you or• qurel p6r li v <br /> A change of name style may to whish you are lleensed.A change In personnel of a pertnersi ar replacement of a resp <br /> v"gn gingen a lo,a cannot be he smade with this form. <br /> tncnaging crop y <br /> CMANG8 Ns- IiAMi ei <br /> TO-- <br /> List bi•n below names of individuals or pOrirand current rasller►ee eddressl Use reverse Ade pornG>t Al2j2 t s <br /> pint rr NANttt <br /> Ml Mti INITIAL LAvT NAMR <br /> I hereby certlfr V11410p•nahy of perjury ur+der Nle lows of the State of California to the Mv►h and accuracy of the above ctarenl•nK' <br /> Signature of Owlet or Parenar <br /> Date <br /> CORPOWATION NAMR CKANGS—ONLY of State's Office and if the norms style do <br /> you ars pcensd. Notice of o change at officers <br /> A change of nam•style may b• mold*If the Shang•of non+•has bean reylslered at the rotary <br /> not indlcots you are qualified irr a elatsiflaatlon other than ihs Clastificot+an(t) In Which y <br /> responsible managing officerI* cannot be mode with this form. <br /> iNCWD lTH Ttiia FORM PRpO} OF CFIANG{E df CORPOttATE NAh <br /> PROM THE SICKETAItY OF SIT Is OFpICl. \ <br /> CKAbi411 Nsw NA19e »ti W11is'a.Mi <br /> l0 WTD seem TAR( •TMCy No CoA./ 0;= <br /> TO..r. Cp�►pryRAeT71aN µ0. <br /> pATR aMANe1 O/ NAMR R�i01STSRee (MOs �l•Yt<1v rOM eeA1 1f328 % <br /> wn�+ssaRsT+►+rti ae n�T•' Febr 'V 4 19 <br /> ,� under <br /> the tows ofthe State a/Cal 11110� ,a to th.truth and acsv�ry e►rho o�rat• <br /> ►hereby coral under • alty <br /> of perjury <br /> Y p/. te r... e i •.�wt 1'5'##J er <br />
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