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DRAFT <br /> <br /> <br />Signature/Authorized Official Date <br /> <br /> <br />Name <br /> <br />Title <br /> <br /> Address <br /> <br /> City/State/Zip <br /> <br />Telephone Number <br /> <br />Chris Zapata <br />City Manager <br />835 East 14th Street <br />San Leandro, CA 94577 <br />510/577-3354