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SITE INFORMATION AND CORRESPONDENCE_FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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5491
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3500 - Local Oversight Program
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PR0545028
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SITE INFORMATION AND CORRESPONDENCE_FILE 1
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Last modified
12/6/2019 2:59:14 PM
Creation date
12/6/2019 2:48:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 1
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br /> State of CALIFORNIA <br /> County of ORANGE <br /> On SEPTEMBER 10, 2004 before me DOLORES MUIR, NOTARY <br /> PUBLIC <br /> personally appeared PATRICIA M. WHITE <br /> ® personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence <br /> the person(a) whose nameKis/subscribed to <br /> the within instrument and acknowledged to me that <br /> he/she/t4ey-executed the same in Pfi s/her/their <br /> DOLORES MUIR authorized capacity(ie4, and that by his/her/tf reir <br /> Commfsslon If< 1508753 signature(s)'on the instrument the person(s), or the <br /> •'� - Notary PubftC - California entity upon behalf of which the persons) acted, <br /> Orange County - executed the.instrument. <br /> My Comm.E)Pires Aug 19.2M8 <br /> WITNE my and and official seal. <br /> Notary Public Seal <br /> OPTIONAL <br /> Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. <br /> DESCRIPTION OF ATTACHED DOCUMENT: <br /> TITLE OR TYPE OF DOCUMENT: BOND <br /> DOCUMENT DATE: SEPTEMBER 10 2004 <br /> CAPACITY(IES) CLAIMED BY SIGNER(S) <br /> Signer's Name: PATRICIA M. WHITE Signer's Name N/A <br /> ❑INDIVIDUAL ❑INDIVIDUAL <br /> ❑CORPORATE OFFICER ❑CORPORATE OFFICER <br /> Tifle(s) Title(s) <br /> ❑ PARTNER(S)E]LIMITED ❑ GENERAL ❑ PARTNER(S)1:1 LIMITED ❑ GENERAL <br /> ® ATTORNEY-IN-FACT ❑ ATTORNEY-IN-FACT <br /> ❑ TRUSTEE(S) ❑ TRUSTEE(S) <br /> ❑ GUARDIAN/CONSERVATOR ❑ GUARDIAN/CONSERVATOR <br /> ❑ OTHER: ❑ OTHER: <br /> Signer is representing: Signer is representing: <br /> NAME OF PERSON(S)OR ENTITY(IES) NAME OF PERSON(S)OR ENTITY(IES) <br /> CONTRACTORS BONDING AND INSURANCE COMPANY <br />
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