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Environmental Health - Public
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2900 - Site Mitigation Program
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PR0515453
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
12/11/2019 5:02:52 PM
Creation date
12/11/2019 4:21:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0515453
PE
2950
FACILITY_ID
FA0012156
FACILITY_NAME
NORTH SHORE PARCEL
STREET_NUMBER
0
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95202
CURRENT_STATUS
01
SITE_LOCATION
FREMONT ST
QC Status
Approved
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EHD - Public
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT <br /> State of California <br /> II __ ss. <br /> County of '�(P on (fn t P,N�T' <br /> Onbefore me, �'o IaiyL� t <br /> Date limit Title of Officer(e.g.,•Janl�Notary Public") <br /> j J <br /> personally appeared <br /> / Name(s) tigner(s) <br /> personally known to me <br /> ❑ proved to me on the basis of satisfactory evidence <br /> to be the person(s) whose name(s) is/are subscribed <br /> to the within instrument and acknowledged to me that <br /> KATHLEEN C.DUNCAN he/she/they executed the same in his/her/their <br /> Commission# 1628225 authorized capacity(ies), and that by his/her/their <br /> -e< Notary Public -California signature(s) on the instrument the person(s), or the <br /> Sacramento county - entity upon behalf of which the person(s) acted, <br /> MyComm.Expires Dec 9,200 executed the instrument. <br /> WITNESS my hand and official seal. <br /> Place Notary Seal Above .OJ.�/ <br /> Signature of Notary Public <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: Numbe ages: <br /> Signer(s) Other Than Named Above: <br /> n <br /> Capacity(ies) Claimed by Signers) <br /> Signer's Name: A 11 Signer's Name: <br /> ❑ IndividualEIIndividual <br /> ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): <br /> ❑ Partner—❑ Limited ❑ General ❑ Partner—❑ Limited ❑General <br /> ❑ Attorney In Fact affffim <br /> Top of thumb here El Attorney in Fact Top of thumb here <br /> O Trustee E) Trustee <br /> C1 Guardian or Conservator ElGuardian or Conservator <br /> E3 Other: ❑ Other: <br /> Signer Is Represe ng: Signer Is Representing: <br /> 0 2004 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402 Item No.5907 Reorder:Call Toll-Free 1-800-876-6827 <br />
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