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ARCHIVED REPORTS XR0006092
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0006092
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Entry Properties
Last modified
6/21/2019 1:16:31 PM
Creation date
6/21/2019 10:26:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006092
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br /> State of California <br /> ss <br /> County of SAN JOAQUIN <br /> on 413101 _, before me, KELLY <br /> Date Name and Title of oNlcer( y "Jane oe otary u is <br /> personally appeared MARY ANN WEBBER <br /> Name(s)01 signer(s) <br /> 0 personally known to me <br /> ❑ proved to me on the basis of satisfactory <br /> evidence <br /> to be the person(s) whose name(s) is/are <br /> KELLY M STEPHENS r subscribed to the within instrument and <br /> COMM #1293349 Macknowledged to me that he/she/they executed <br /> NOTARY PUBLIC, CALIFORNIA the same in his/her/their authorized <br /> 4-01 <br /> SAN J0AQ�Ir. ;;OUNTV -16 <br /> Ivry Carnet ssior Fralrf-S 2005 <br /> capacEty(ies), and that by his/her/their <br /> `F <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 /> WITNESS my hand and official seal <br /> Place Notary Seal Above Signature of Notary P x: <br /> OPTIONAL. <br /> Though the information below is not required by law,it may prove valuable to persons relying on the document <br /> and could prevent fraudulent removal and reattachment of this form to another document <br /> Description of Attached Document <br /> Title or Type of Document <br /> Document Date Number of Pages <br /> Signer(s) Other Than Named Above <br /> Capacity(les) Claimed by Signer <br /> Signer's Name <br /> ❑ Individual 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 /> Signer is Representing <br /> a 1997 National Notary Assocmtron•9350 De Soto Ave PO Sox 2402•Chatsworth CA 91313.2402 Prod No 5907 Reorder Call Toll Free 14M00-876-8827 <br />
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