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3500 - Local Oversight Program
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PR0545742
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/9/2020 9:39:46 AM
Creation date
6/9/2020 9:37:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545742
PE
3528
FACILITY_ID
FA0005564
FACILITY_NAME
RIVERA, ANTHONY
STREET_NUMBER
15971
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
15971 TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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m SEND <br /> b ■comps de s 2 for additional services. <br /> ■compl a items 3, a,and 4b. So w!Sh to receive the <br /> "■Print your name'and address on the revers of this fprm o t foriowin fn <br /> card fo you, can re this �CCe�(�r {�, <br /> ■Attach this form to the from of the mailpie ,a extra fe >�C6 l/ �7 .7 <br /> permit. • ❑ Addressee's Address ° <br /> a! .?,■Write Retum Receipt Requested"ori the mail CB to he articl num er. .� 'e <br /> $ ■The Return Receipt will show to whom the article w s delivered and the date 2. ❑ Restricted Delivery � <br /> 0 delivered. <br /> °,t 3-Article-Addressed-to. <br /> Consult postmaster for fee. <br /> 2GARY e_Addressed_to_ _ 4a.Article er <br /> CL <br /> v a <br /> -DEI. CARLQ _._..— _ Numbo- <br /> E DELTA AIR STRIP 4b,Service Type / p. <br /> 15971 -S TRACy BLVD ❑ Registered °' zl 1"n <br /> Certifi <br /> TRACY CA 95375 13 Express Mair °3 <br /> Insure S lR: <br /> o <br /> ❑ Retum Receipt for Merchajidise ❑ CPD R Ln ep <br /> 7.Date Qf eliv {y f o k� �, <br /> ILD <br /> 5.Received (print Name) <br /> S.Add ee's dd ess(p y if requested a , <br /> W /% <br /> and fee is p d� C <br /> 6.Signator -(A ee Age t) <br /> PS�Form 3 51 December 1 9 Domestic Return Receipt <br />
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