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SERVICE REQUEST - (EN 00 61) NOVIed 8/23/93 <br /> FACILITY 10 / RECORD ID ! - q INVOICE / <br /> FACILITY RARE T-incoln Unified School District Ma.intainence Yard BILLING PARTY Y, / N � <br /> 6749 Harrisburh Place <br /> SITE ADDRESS <br /> Stockton, a ZIP <br /> 95207 <br /> till . <br /> UAUER/OPERAIRNI Lincoln Unified 'School District BILLING PARTY / M <br /> TEA l 1 I(. t1- l l PHONE EI ( 209 )953 ,8700 <br /> ADDRESS 2010 W. Swain Rd. PHONE 02 t ) <br /> CITY Stockton, STATE CA ZIP 95207 <br /> p APH RpLord Use Applleetlon a <br /> I I Bf14 Dlst Location Come l l <br /> e <br /> CONTRACTOR and/or <br /> SERv10E REOA?STOR Jim .Thorpe Oil. Inc. - BILLING PARTY / <br /> DNA tt tT PHONE SI ( 209 )_ j$ 0175 <br /> MAILING ADDRESS <br /> P.O. Box 357 FAX 9 ( 209 ) 368 ; 1851 <br /> CITY Lodi. STATE CA ZIP 95241-03;7 <br /> HALING ACKNOULEDGERENII I, the underslgned owner, operator or agent of some, acknowledge that all site and/or pro)ect specific <br /> PRS/END hourly cheroot associated with this facility or activity will be billed to the party Identlfled as the BILLING PARTY on <br /> Page 1 of this form. <br /> I also certify that I have prepered this application end thata work to be perforwed will be done In accordome with all SAN <br /> JOAOOIN COUNTY Ordinance Codes ards, St laws. PAY MQ41 <br /> REGE.NEr <br /> APPLICANT'S SIGNATURE r <br /> Contractor 7(21/98 JUL <br /> Title: Onter r r. <br /> ��QQyyS�Ay}N dOyA�GLUIN COUgqNyyTCCt" <br /> AUTHORIZATION to RELEASE INFORRAtIONi, In addition to the above, when applicable,lcabl e, .1,. the owner, F"EM'Fn[ 1PPU of, <br /> the properly located at the above site address hereby authorlre the release of any and all resu is gauteohnlcal data and/e1',-''I' <br /> am irorsnenNl/aIle assessment Information to SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL BERLIN DIVISION as Boon o <br /> It Is available and at the same time It Is provided to me or we representative. <br /> Nature of Service No Ott service Code <br /> Assigned to Employee 0 "1 I p 7� Date 2/_,.Z„�y <br /> Date Service Completed / / Further Action Requiredr Y / N PROGRAM ELEVEN( <br /> fee Amount Amount Paid <br /> Dote of�}Papment Payment type Receipt B Check S Recvd By.. <br /> UNIT CLK <br /> SUPV _ —�--/— ACCT <br />