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DA VINCI
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2900 - Site Mitigation Program
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PR0543804
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COMPLIANCE INFO
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Entry Properties
Last modified
6/11/2021 4:43:55 PM
Creation date
6/11/2021 3:18:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0543804
PE
2950
FACILITY_ID
FA0024907
FACILITY_NAME
7-ELEVEN STORE #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\dsedra
Tags
EHD - Public
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AGENCY CUSTOMER ID: CASCDR <br />LOC #: <br /> <br />ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> <br />AGENCY <br />Crystal & Company <br />NAMED INSURED <br />Cascade Drilling, LP <br />17270 Woodinville Redmond Rd NE <br />Suite 777 Bldg A <br />Woodinville WA 98072 <br />POLICY NUMBER <br />CARRIER NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />WORKERS' COMPENSATION: Waiver of Subrogation when required by written contract (WC000313) <br />All of the above is in accordance with the policy provisions and endorsements reflected. <br />Evidence of Insurance <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />ACORD 101 (2008/01)
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