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SITE MITIGATION ACKNOWLEDGMENT/REaJEST FOR SERVICES F�1 + <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH D V 9` <br /> SITE INFORMATION <br /> TH AGENCY <br /> ITE NAME Southeast Corner of Arch & Kingsley Roads AGENCY CONTACT <br /> PHONE <br /> DRESS 3568 East Arch Road APN 0 <br /> 181-120-01 <br /> E <br /> Stockton (San Joaquin County) lip <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Balbi & Chang Associates <br /> AILING ADDRESS 151 Link Road, <br /> Cordelia TATE IP CA 94585 <br /> ITY <br /> ONTACT NAME Long Ching HONE 707-864-2020 <br /> PROPERTY OWNER/OPERATOR <br /> AME Obed W. Hill & Mildred 0. Hill HONE 209-931-1709 <br /> DRESS 5723 Cherokee Lane <br /> ITY Stockton IS <br /> TATE CA IP <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME Barghausen Consulting Engineers, Inc. HONE 1 916-348-3057 <br /> DRESS 4612 Roseville Road, Suite 103 <br /> ITY North Highlands TATE I CA IP 1 95660 <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, OF THE PROPERTY LOCATED AT THE ABOVE SITE ADDRESS HEREBY <br /> AUTHORIZE THE RELEASE OF ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> ADDITIONALLY, 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE AND/OR PROJECT SPECIFIC <br /> PHS/EHD HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> APPLICANT'S NAME, TITLE, SIGNATURE/DATE <br /> S# <br /> AME Long Ching <br /> ATE 6/27/91 <br /> 1GNATURE T- <br /> :Balbi & Chang Associates Senior Engineer <br /> OMPANY <br /> 1TLE <br /> PAGE ONE OF TWO <br /> 89.007(1V)12/90BILFRMI2 <br /> EH 2901 ` <br />