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06/08/98 15:39 $`19163645633 HLA SACRAMENTO ` - — <br /> 6—&-1998 2:S5PM FROM- P. 2 <br /> SERVICE REQUEST (EH 00 61) Revised 8/23/93 <br /> ' ;AC1lITT ID R' RECORD ID R OIS 8 10 INVOICE % <br /> .FACILITY RAMR 'Newark Sierra Panarhnard Mi 1 l c BILLING PARTY <br /> ,SITE ADDRESS 800 W at Chs rrh Arraar <br /> CITY Stockton CA ZIP 95903 <br /> 0"IlI PBRATdI Newark Sierra PapQrboard Corporation BILLING PARTY T / N <br /> DBA ,Newark Sierra Paperboard Mills PHONE #1 (209 ) 466- 7088ext.312` <br /> ADDRESS 800' WeeC Church Street PHONE 112 ! ) <br /> CITY Stockton STATE CA ZIP o59113 <br /> 4' <br /> F APN R land Uae Application % <br /> - I„ r 1 BOS Dist Location Code <br /> CONTRACTOR and/or <br /> SERVICE REWESTOR Aa rding T.nme,... eva•...i a.ve r_..,...,.r TTLC BILLING PARTY <br /> DDA Harding Taman➢ oQeAga�atag. PHONE 01 C 916 )364 -7l1O3 <br /> lltitl NG ADDRESS 10965 Rnrkingl.nm nr i 1 Sn FAX 0 (916 ) 164 - 5(,33 <br /> CITY Snrramenrn STATE en ZIP 951197 <br /> BILLING ACKNOWLEDGEMENT: 1, the undersigned owner, operator 4a enc f same, acknowledge that ail site and/or project specific <br /> PNS/EHD hourly charges associated with this facility or activity will be bitted to the party Identified as the BILLING PARTY on <br /> Page 1 of this form. <br /> I`also certify that I have prepared this application and that the work to be performed rflP ltl CaedMca,rith at I, SAN <br /> A WIN COUNTY Ordinance Codes and St ods, stat and Federal Lara. RECEIVED <br /> Y <br /> i <br /> j Mlrl1NPs SIGNATURE JUN <br /> any D. Haeck, P D. , .G. <br /> r' Project Geologist _Date:7htr. I _ 6/5/98 SAN Ennn,,,..__-. <br /> ELIC HEALTH SERVICES <br /> ENVITA <br /> MULIC I t�LFf1��°n��� <br /> AUTHORIZATION TO RELEASE INFORMATION[ In addition to the above, When applicable, 1, the owner, oparatWbysmwt of some, of <br /> the property located at the above site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site assessment information to SAN JOAWIN COUNTY PUBLIC HEALTH SERVICHS ENVIRONMENTAL HEALTH DIVISION as soon as <br /> It Is available and at the sane tiffs it is provided to me or my representative. <br /> mature of service Roque is some* code C>3 <br /> Assigned to Eqpt oyes 0 4 Date <br /> ,fete Service Canptsted _/ / Further Action Required:: T' / N. PROGRAM ElfdlsNT 2� t r' <br /> Fee Amount Amount paid Date of Payment Payment Ty Recttpt d Chick / Reed By <br /> .3S1 3_51 3C7OMD40j <br /> RENS SLAV /_/�_ ACCT UNIT CLK _/ / <br />