ML18179A266

Enclosure 10 - California All Purpose Acknowledgment of Smud Affirmation Pursuant to 10 CFR 72.16(b)

ML18179A266
Person / Time
Site:	07200011
Issue date:	06/25/2018
From:	Johnson L Sacramento County, CA, Sacramento Municipal Utility District (SMUD)
To:	Office of Nuclear Material Safety and Safeguards
Shared Package
ML18179A255	List: ML18179A256 ML18179A258 ML18179A260 ML18179A266
References
CAC 000993, CAC 001028, DPG -18-114, EPID: L-2018-LNE-0004, EPID: L-2018-RNW-0005
Download: ML18179A266 (2)

Text

Enclosure 10 to DPG-18-114 California All Purpose Acknowledgment of SMUD Affirmation Pursuant to 10 CFR 72.16(b)

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of Californl~

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On ~i n.L ¢5, /)fJ l B before me, la..£tYw ~~ h h abl>Vl 1 No-6..vit Date Here lnse[!J/.JJ and Title of the Officer

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personally appeared -~~=-------'i.v\\=~~A_.--.-~\\

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Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies}, and that by his/her/their signature(s) on the instrument the person(s),

or the entity upon behalf of which the person(s) acted, executed the instrument.

LAURIE LEIGH JOHNSON

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Notary Public - California z

Sacramento County Commission# 21 88409 My Comm. Expires Mar 26, 2021 Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document.

Description of Attached Document Title or Type of Document: ____________________________ _

Document Date: ___________________ Number of Pages: _____ _

Signer(s) Other Than Named Above: _______________________ _

Capacity(ies) Claimed by Signer(s)

Signer's Name: ____________ _

D Corporate Officer -

Title(s): ______ _

D Partner -

D Limited D General D Individual D Trustee D Attorney in Fact D Guardian or Conservator D Other: ______________ _

Signer Is Representing: _________ _

Signer's Name: ____________ _

D Corporate Officer -

Title(s): ______ _

D Partner -

D Limited D General D Individual D Trustee D Attorney in Fact D Guardian or Conservator D Other: ______________ _

Signer Is Representing: _________ _

©2016 National Notary Association

• www.NationalNotary.org

• 1-800-US NOTARY (1-800-876-6827)

Item #5907