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EHD Program Facility Records by Street Name
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4200 – Liquid Waste Program
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PR0526172
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Entry Properties
Last modified
2/5/2026 4:46:38 PM
Creation date
8/5/2020 10:00:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200 – Liquid Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0526172
PE
4242 - WASTE WATER TX PLANT
FACILITY_ID
FA0017710
FACILITY_NAME
NATIONAL PSYCHIATRIC CARE & REHAB SVCS SJ
STREET_NUMBER
401
Direction
S
STREET_NAME
AIRPORT
STREET_TYPE
WAY
City
MANTECA
Zip
95336
APN
24130052
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
FilePath
\MIGRATIONS\4200 - Liquid Waste\A\AIRPORT WAY\401\PR0526172\INSPECT CORRESPOND.PDF
Site Address
401 S AIRPORT WAY MANTECA 95336
Tags
EHD - Public
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LLC-12 19-C27903 <br /> Secretary of State <br /> i Statement of Information FILED <br /> Limited Liability Company) <br /> In the office of the Secretary of State <br /> of the State of California <br /> IMPORTANT—Read Instructions before completing this form. <br /> Filing Fee—$20.00 JUN 13, 2019 <br /> Copy Fees—First page$1.00'each attachment page$0 50, <br /> Certification Fee-$5 00 plus copy fees This Space For Ofree Use Only <br /> 1. Limited Liability Company Name IEnte'the oxacl name of the LLC it you registered in Ca forma using an allernale name e nsfru'i ens) <br /> NATIONAL SAN JOAQUIN LLC fo.med outs•de of California) <br /> 2. 12-Digit Secretary of State File Number 3. State,Foreign Country or Place of orgarization(only' <br /> 201916310574 CALIFORNIA <br /> 4. Business Addresses _ Su:e Lv Coda <br /> COY(no ebb+enatiais) CA 95337 <br /> • Siren Addross of principal orrice�Po not list.P O Box MANTECA <br /> 401 SOUTH AIRPORT WAY sate by Code <br /> coy(no abbmviations) CA 95134 <br /> b Mailing Address o1 LLC if different thin hem 4 SAN JOSE <br /> 2880 ZANKER RD. STE 106 stale Zip Code <br /> c Street Address of California Office.d or b <br /> item 4a is not in California-Do nor a P o Box ply Ina abber'ations) CA 95337 <br /> 401 SOUTH AIRPORT WAY MANTECA — <br /> II no manages nave been appointed or elected.provda the name and address of each member At least one name n address <br /> must be fisted If the manageomember is an Individual.complete Items Sa and 5c(lea.e Item 5b blmana manager or membeif the rr�neheb LLC <br /> S. Manager(s)or Member(a) an enldy,wmpiele Items 5b and 5C(leave Item Sa titans) Note The LLC cannot serve as its ow* ) g <br /> has adoitional managefymembers,enter the name(s)and addresses on Form LLC 12A(_,•r• Sudh. <br /> Middle Nam. Last Name <br /> a First Name ofen individual Do not complete Item Sb RUDAKOV <br /> ALEX <br /> b Entity Noma Do not complete Item Sa <br /> State Zip Code <br /> c Address City abbrov+ CA 94010 <br /> 1425 SAN RAYMUNDO RD. _ HILLSBOROUGH <br /> 6. Service of Process(Must provide ether Individual OR Corporation) <br /> INDIVIDUAL-Complete Items 6a and lib only Must include agent's full name and California street address ' <br /> Middle Name Las'Name <br /> a Cnhlania Agent First Name(ifnt f age is not a corporation) RUCAKOV <br /> ALEX ii sate Zip Code <br /> 28801ZANKtIR RDnSUITIOfit D°not.nur.Po ea. ptylroabbrevalims)- -- --_ — - 95134 _ <br /> SAN JOSE CA <br /> CORPORATION-Complete Item 6c only Only Indude the name of the reg stered agent Corporation _ <br /> c Cdlifomo Registered Corporate Agents Name(a agent is a corporation)-Do not complete item 6a or 6b <br /> 7. Type of Business <br /> a Describe the type of business Of samoes of the:imilod Liability Company <br /> RENTAL — — <br /> 13. Chief Executive Officer,if elected or appointed <br /> Mid0l0 Nerve Last'vamo StMis � <br /> a First Name <br /> ply(ro abtxe��ations) Stale Zip Code <br /> b Address <br /> 9. The Information contained herein,Including any attachments,is true and correct. <br /> 06/13/2019 TATIANA CHERKAS ACCOUNTANT <br /> Ddle Type or Print Name of Person Completing the Form Title Signature <br /> Return Address(Optional)(For common Callon from the Secretary of Sate related to this document,or if purchasing a copy or the filed document enter the name of a <br /> prrson or company and the mailing address Th s information Will become publ C when filed Si E iC ',r\S BEFORE COMPLETING) <br /> Name <br /> Company, <br /> Address <br /> CitylState7Zip L <br /> 2017 California Secretary of St <br /> LLC-12(REV 01/2017) Page 1 of 2 ate <br /> YVNw sas ca gNtusrless'be <br />
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