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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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3500 - Local Oversight Program
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PR0544173
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/25/2019 2:04:59 PM
Creation date
2/25/2019 10:25:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0544173
PE
3528
FACILITY_ID
FA0003613
FACILITY_NAME
ARCO STATION #4493*
STREET_NUMBER
205
Direction
N
STREET_NAME
CENTER
STREET_TYPE
ST
City
STOCKTON
Zip
95202
APN
13909003
CURRENT_STATUS
02
SITE_LOCATION
205 N CENTER ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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s <br /> ' I <br /> CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br /> [ - .- - <br /> ( State of California <br /> ss. <br /> ( County of Q rn C_ n tO <br /> J � <br /> f On � � Ca 1 U 2, before me, �e 1E— <br /> , <br /> Date Name a Title of Officer(e.g.,"Jane Doe Notary Public') <br /> ( personally appeared Ja m 5 "7��� i/v <br /> ( - am of Signer(s) <br /> ( <br /> /personally known to me <br /> ❑ proved to me on the basis of satisfactory <br /> BETTY J.ENGLE evidence <br /> • Commission i 1322831 <br /> Notary Public-California to be the person(s) whose name(s) is/are <br /> Sacramento County <br /> My Comm.Expires Sep 29,2005f subs ribed to the within instrument and <br /> acknowledged to me that he/she/they executed <br /> the same in his/her/their authorized <br /> c caps ity(ies), and that by his/her/their <br /> signature(s) on the instrument the person(s), or <br /> the entity upon behalf of which the person(s) <br /> acted, executed the instrument. <br /> ( <br /> WITE my hand and official seal. <br /> [ Place Notary Seal Above 05irr.•or Notary Public <br /> f <br /> OPTI NAL <br /> Though the information below is not required by law, it may p ve valuable to persons relying on the document <br /> and could prevent fraudulent removal and reattachi rient of this form to another document. <br /> Description of Attached Document <br /> 1K Title or Type of Document: <br /> Document Date: {t I j l Number of Pages: <br /> Signer(s) Other Than Named Above: ETt(v � <br /> i <br /> Capacity(ies) Claimed by Signer yy <br /> Signer's Name: l` <br /> (` PIndividual <br /> ( Top of thumb here <br /> ( ❑ Corporate Officer—Title(s): <br /> ( ❑ Partner—❑ Limited ❑ General <br /> [ ❑ Attorney in Fact <br /> [' ❑ Trustee <br /> ( ❑ Guardian or Conservator <br /> (, ❑ Other: <br /> ` 5 <br /> ( Signer Is Representing: <br /> 0 1999 National Notary Association•9350 Pe Soto Ave.,P.O-Box 2402•Chatsworth,CA 91313-2402•www.ialonainalary.org Prod.No.5907 Reorder:Call Toll-Free 1.800-878-8827 <br />
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