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ATTACHMENT <br />America's Job Center of CaliforniasM <br />Change Form - Type 3 <br />locationSection 1. Enter current office prior to any changes <br />Today's Date: 8/13/2024 <br />County: Orange <br />Office Name: Santa Ana WORK Center <br />Street Address: 801 W. Civic Center Drive, Suite 200 <br />City: Santa Ana <br />Zip Code: 92701 <br />Effective Date of Change: N/A <br />Section II. Enter new information <br />Action Codes <br />ITEM NO. <br />A C D Key: A= Add, C= Change, D= Delete No changes <br />1 <br />l <br />r <br />I- <br />Name, Physical Address, <br />City, State, and Zip <br />2 <br />f- <br />I- <br />r <br />Mailing Address (if different) <br />3 <br />r <br />r <br />r <br />Building Name <br />4 <br />r <br />r <br />f County <br />5 <br />r— <br />r— <br />r <br />Public Phone <br />6 <br />r- <br />r- <br />r- <br />Public Fax <br />7 <br />f- <br />r <br />r <br />TTY Number <br />8 <br />r- <br />r <br />r <br />Hours <br />9 <br />r- <br />r <br />r <br />ILevel of service <br />Comprehensive 57 Affiliate r- Specialized r' <br />10 <br />r <br />r <br />r <br />Local Workforce Development Board <br />it <br />r <br />r <br />r <br />Operator <br />12 <br />r <br />r <br />r <br />Veterans Representative <br />Yes r No r <br />13 <br />r <br />r <br />r <br />EDD Staff <br />Yes r No r <br />14 <br />r <br />W <br />r <br />Website Address <br />www.santa-ana.org/WORK-Center <br />15 <br />r <br />Office Manager/Administrator <br />Carlos de la Riva <br />(not for <br />trFo-F- <br />rEmail <br />Address <br />cdelariva@santa-ana.org <br />publication) <br />r <br />Phone Number <br />714-565-2629 <br />Ill <br />ApprovalSection <br />Deborah Sanchez 714-565-2621 dsanchez@santa-a•a.o,• <br />Contact Name (if different from item 15) Phone Email o <br />Deborah Sanchez Econ. Dev. Specialist III/WDB Director A b a� �2U <br />Office Manager/Administrator (type or print name and title) Signature Date <br />