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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0542676
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COMPLIANCE INFO
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Entry Properties
Last modified
12/2/2020 11:18:44 AM
Creation date
7/27/2020 9:04:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0542676
PE
2953
FACILITY_ID
FA0024554
FACILITY_NAME
JOHNS, WILLIAM D
STREET_NUMBER
1640
Direction
N
STREET_NAME
BROADWAY
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
CURRENT_STATUS
01
SITE_LOCATION
1640 N BROADWAY AVE
P_LOCATION
01
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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2020-166965 Page 9 of 9 <br />12/01/2020 01-42-25 PM <br />ACKNOWLEDGMENT <br />A notary public or other officer completing this <br />certificate verifies only the identity of the individual <br />who signed the document to which this certificate is <br />attached, and not the truthfulness, accuracy, or <br />validity of that document. <br />State of California <br />County of San Joaquin <br />On -)-0 — before me, Terri L. Tutt, Notary Public <br />(insert name and title of the officer) <br />personally appeared K *1 (�'6 /"'t- <br />'0' kloAl <br />t", I <br />who proved to me on the basis of satisfactory evidence to be the person s) whose -name(s) is/are <br />subscribed to the within instrument and acknowledged to me that he/she/they executed the same in <br />his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the <br />person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. <br />I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing <br />paragraph is true and correct. <br />a- - <br />WITNESS my hand and official seal, TERRI L, TUTT <br />Notary Public - Callforn a <br />San Joaquin County <br />Commission # 2176433 <br />MyComm, Expires Jan 18, 2021 <br />Signature <br />(Seal) <br />
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