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EHD Program Facility Records by Street Name
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3400 – Cannabis Program (Commercial)
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PR0546332
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COMPLIANCE INFO
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Entry Properties
Last modified
10/25/2021 10:31:01 AM
Creation date
10/25/2021 10:11:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3400 – Cannabis Program (Commercial)
File Section
COMPLIANCE INFO
RECORD_ID
PR0546332
PE
3423
FACILITY_ID
FA0026251
FACILITY_NAME
CULTIVA LLC
STREET_NUMBER
12811
STREET_NAME
DROGE
STREET_TYPE
RD
City
ESCALON
Zip
85320
CURRENT_STATUS
01
SITE_LOCATION
12811 DROGE RD BLDG C & D
P_LOCATION
06
QC Status
Approved
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EHD - Public
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CALIFORNIA ACKNOWLEDGMENT CIVIL CODE § 1189 <br /> A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document <br /> to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. <br /> State of California l <br /> County of San Joaquin J} <br /> On September 2,2020 before me, Pam Galbreath,Notary Public <br /> Date Here Insert Name and Title of the Officer <br /> personally appeared Donald Blevins and Tammy Blevins <br /> Name(s)of Signer(s) <br /> ------------------------------------------------------------------------------------------------------------------------------ <br /> who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed <br /> to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their <br /> authorized capaciry(ies),and that by his/her/their signature(s)on the instrument the person(s),or the entity <br /> upon behalf of which the person(s)acted,executed the instrument. <br /> I certify under PENALTY OF PERJURY under the <br /> PM GALBREATH laws of the State of California that the foregoing <br /> 0 COMM. X15221 ; <br /> paragraph is true and correct. <br /> m0VWv ruawo-oasaMw <br /> am tea+ooLwr► 0 WITNESS my hand and official seal. <br /> w oort KV.AMMY mM <br /> Signature LDa--� <br /> Place Notary Seal and/or Stamp Above Signature of Notary Public <br /> OPTIONAL <br /> Completing this information can deter alteration of the document or <br /> fraudulent reattachment of this form to on unintended document. <br /> Description of Attached Document <br /> Title or Type of Document: Property Owners Statement of Consent <br /> Document Date: September 2 2020 Number of Pages: 1 <br /> Signer(s) Other Than Named Above: None <br /> Capacity(ies) Claimed by Signer(s) <br /> Signer's Name: Donald Blevins Signer's Name: Tammy Ble%gns <br /> ❑ Corporate Officer—Title(s): ❑ Corporate Officer— Title(s): <br /> ❑ Partner— ❑ Limited ❑ General ❑ Partner— ❑ Limited ❑ General <br /> * Individual ❑ Attorney in Fact ® Individual ❑ Attorney in Fact <br /> ❑ Trustee ❑ Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator <br /> ❑ Other: ❑ Other: <br /> Signer is Representing: Signer is Representing: <br /> 02018 National Notary Association <br />
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