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Environmental Health - Public
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2900 - Site Mitigation Program
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PR0515319
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/1/2020 12:19:33 PM
Creation date
6/1/2020 12:17:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0515319
PE
2950
FACILITY_ID
FA0012088
FACILITY_NAME
WESTERN SPRAY PAINT
STREET_NUMBER
107
STREET_NAME
VAL DERVIN
STREET_TYPE
PKWY
City
STOCKTON
Zip
95206
APN
19337005
CURRENT_STATUS
01
SITE_LOCATION
107 VAL DERVIN PKWY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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0 0 NC <br /> STATE P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 <br /> COMPENSATION <br /> INSURANCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> POLICY NUMBER. 1221984 - 99 <br /> ISSUE DATE: 02-01-99 - CERTIFICATE EXPIRES. 02-01-00 <br /> GERAGHTY & MILLER INC <br /> ATTN: KENT O'BRIEN <br /> 1050 MARINA WY SO <br /> RICHMOND CA 94804 <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br /> California Insurance Commissioner to the employer named below for the policy period indicated. <br /> This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. <br /> We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. <br /> This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br /> by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document <br /> with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the <br /> policies described herein is subject to all the terms, exclusions and conditions of.. such <br /> ''policies. <br /> /�"/�/ <br /> PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. <br /> ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02/01/99 IS ATTACHED TO AND <br /> FORMS A PART OF THIS POLICY. <br /> EMPLOYER LEGAL NAME <br /> PRECISION SAMPLING INC PRECISION SAMPLING INC <br /> 47 LOUISE ST <br /> SAN RAFAEL CA 94901 <br /> 01-28-99 <br /> PRINTED: P0408 <br />
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