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COMPLIANCE INFO_1999 - 2003
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231455
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COMPLIANCE INFO_1999 - 2003
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Last modified
11/17/2023 10:21:50 AM
Creation date
4/28/2020 11:32:03 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1999 - 2003
RECORD_ID
PR0231455
PE
2361
FACILITY_ID
FA0003612
FACILITY_NAME
Yosemite Avenue Arco AmPm
STREET_NUMBER
1711
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
Ave
City
Manteca
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
1711 E Yosemite Ave
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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KBlackwell
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EHD - Public
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S,. <br /> STATE P.O. bOX 807, SAN FRANCISCO,CA .94101'-0807 <br /> COMPENSATION <br /> INSURANCE <br /> F U N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> �.POLICY N MBER: 046-02 UNIT 0006359 <br /> ISSUE DATE: 01-01-02 CERTIFICATE E PIRES: 01-01-03 <br /> CONTRACTORS STATE LICENSE BOARD JOB: LIC #675998 <br /> ATTN WORKERS' COMPENSATION DEPARTMENT INCEPTION DATE 01-01 c. <br /> P 0 BOX 26000 0.0. : SOUTH ORANGE <br /> SACRAMENTO CA 95826 <br /> This is to certify that we have issued a valid Workers' Compensation insurance polic in a .form approved by the <br /> California Insurance Commissioner to the employer named below for the policy,period indicated. <br /> This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer <br /> We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. <br /> This certificate of insurance is not an insurance policy and does not amend, extendr alter.the coverage afforded <br /> by the policies listed herein. Notwithstanding any requirement, term, or condition of a 4,ny contract or other document <br /> with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the <br /> policies described herein is subject to all the terms, exclusions and conditions of such policies. <br /> PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1 ,000,000.00 PER OCCURRENCE. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01/01/02 IS ATTACHED TO AND <br /> FORMS A PART OF THIS POLICY. <br /> EMPLOYER LEGAL NAME <br /> I . <br /> PETCON TECH, INC PETCON TECHNOLOGIES INC (A CORP) <br /> 14118 INGLEWWOD' AVE <br /> HAWTHORNE CA 90250 <br /> PRINTED: 12-18-01 PO4 1 C <br /> �.t. •g;�, • • - .. r� • TT i• �,-1 <br />
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