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�J SERVICE kEa11EST (EH 00 61)'Revisid 8/t#MM <br /> `/' FACILITY ID # .RECORD 10 # 3 - INVOICE #- '11x:.. <br /> FACILITY NAME PA=C BMI, - <br /> WE ADDRESS 1413 BOURBON STREET <br /> CITY STOCK M CA ZIP <br /> ONNER/OPERATOR PACIFIC BELL BILLING PARTY Y / N SS". <br /> DBA PHONE #, ( 510 )823- • 7777 <br /> ADDRESS PO BOX 5095 RM 1N200 PHONE #2 ( 415 ).331 . -0924 <br /> CITY SAN RANION STATE ('A. ZIP. 94583-(lana--�--'."- - - <br /> APN a_ _ _ _ u�a . I:�.---.. - _ - ----------- -- 408 3 <br /> - � <br /> AMOUNT <br /> EXPLANATION <br /> ARONSON11297 � Raed ,, <br /> e�ENGINEERING R--,- �• U 95670 m= <br /> (916) 631-1616 <br /> I N C O R P O R A T E D �� CHECK _. <br /> DOLLARS AMOUNT <br /> ` <br /> rMECK <br /> PAY <br /> �• miHUs i FM.A 3TATE ad i NUMBBEE <br /> R <br /> AMOUNT �'( oaoss Q _ <br /> OF TO THE ORDER <br /> TE <br /> `� 11 DEgtRIPT10N <br /> 1 1011 <br /> .•Y <br /> STOCKMANS BANK OF COMMERCE ^nom <br /> ELK GROVE,CA 95759 <br /> ' : ' -- -_ <br /> (e PROJECT MANAGER/ARONSON ENGINEERINGtSNQate: 8/19/96 u <br /> ,c <br /> ` -AUTHORIZATION TO RELEASE INFORMATION& In addition to the above, whenspplicable, I/ the owner, operator. or &genua <br /> .-...the property located at the above site address hereby authorize the release of any and all results, geotechnicai dat YNR; <br /> anvironmental/site assessment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as a.06M;b <br /> it available and at the same time it is provided to me or my representative. -IV IL <br /> v - Service Cote <br /> ,. Nature of Service Request: �/I • <br /> Assigned to Enployee # _ ` Date <br /> -Date Service Completed _/ / Further Action Required: Y / N PROGRAM ELEMENT. <br /> t <br /> Fee Amount : Amount Paid Date of Payment Payment Type Receipt # Cheek # , Reevd <br /> REHS /_/_ SUPV _/_/` ACCT _f_ UNIT CLK <br />