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COMPLIANCE INFO_2020
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231417
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/31/2020 10:27:57 AM
Creation date
6/8/2020 10:00:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231417
PE
2361
FACILITY_ID
FA0003780
FACILITY_NAME
TRACY SHELL*
STREET_NUMBER
3725
Direction
N
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
APN
21217030
CURRENT_STATUS
01
SITE_LOCATION
3725 N TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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RECE VED <br /> � 1 2020 <br /> JUL <br /> ENVIRONMENTAL HEALTH <br /> CALIFORNIA ALL= PURPOSE ACKNOWLEDGMENT D CNILTG`� DV§ 1189 <br /> A notary public or other officer completing this certificate verifies only the identity of the individual who signed the <br /> document to which this certificate is attached , and not the truthfulness, accuracy, or validity of that document. <br /> State of California ) <br /> County of San Diego ) <br /> On " i " Z� ?� before me , QVC DQE (JS Notary Public , <br /> Date � Here Insert Name and Title of the Officer <br /> ' / A <br /> personally appeared r " `a �Lo� ILL) D ; OA a ` p <br /> Name(s) of Si ner(s) <br /> who proved to me on the basis of satisfactory evidence to be the person (4 whose name(? is/are <br /> subscribed to the within instrument and acknowledged to me that he/&heMirey executed the same in <br /> his/bero4heir authorized capacity(, and that by his/he4t4sir signatureK on the instrument the person( , <br /> or the entity upon behalf of which the person) acted , executed the instrument. <br /> I certify under PENALTY OF PERJURY under the laws <br /> of the State of California that the foregoing paragraph <br /> is true and correct. <br /> °L :: BARBARA J . DANIELS ;P WITNESS my hand and official seal . <br /> U COMM . # 218901S <br /> 0 a + ` : NOTARY PUBLIC - CALIFORNIA <br /> d Id <br /> SAN DIEGO COUNTY Q ��i� 1 . �iu <br /> < < COMM , EXPIRES APRIL 27, 2021 -' Signature <br /> Signature of Notary Public <br /> Place Notary Seal Above <br /> OPTIONAL <br /> Though this section is optional, completing this information can deter alteration of the document or <br /> fraudulent reattachment of this form to an unintended document. <br /> Description of Attached Doc me t V 473 <br /> Title or Type of Document : 10 5 b uvte bocument Date : f ` - ZO Z�o <br /> Number of Pages : I Signer(s) Other Than Nan ed Above: <br /> Capacity(ies) Claimed by Signer(s) <br /> Signer's Name: Signer' s Name : <br /> Corporate Officer — Title(s) : ❑ Corporate Officer — Title (s) : <br /> Partner — I ] Limited El General ❑ Partner — 1 Limited -1 General <br /> -i Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact <br /> Trustee ❑ Guardian or Conservator ❑ Trustee LI Guardian or Conservator <br /> ❑ Other: ❑ Other : <br /> Signer Is Representing : Signer Is Representing : <br />
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