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15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond J hour minimum <br /> permit payment per tank. Ir the party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name _ /T�L %�7 -/'3 a/,?/ <br /> /T/ <br /> Mailing Address ��s� 0G,1a <br /> Day Phone Number 3 Z <br /> A ��C� <br /> Signature <br /> Date <br /> Page 6 <br />