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A <br /> SITE MITIGATION ACKN EDGMENT/REQUEST FOR SERVICES FORM <br /> SAN JOAGVIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION <br /> THEN LEAD AGENCY <br /> IrE NAME AGENCY CONTACT <br /> r Sunboro Development Corporation <br />." ORE$$ Byron Road and Corral Hollow Road APN a 237-170-44 <br /> ITY Tracy IP <br /> BILLING ! RESPONSIBLE PARTY INFORMATION <br /> AME Sunboro Development Corporation c/o Randy M. Hess <br /> ILING ADDRESS Adleson, Hess, Chris ensen & Kelly <br /> Y T �..�... r- �..,, .�.�_ �.... .�-110 North Third <br /> TATE ._CA� .:_ _ IP 9.5.112 <br /> tTY' San moose <br /> NucT NAME Randy M. Hess H06iE (4 0 8 297-66 <br /> 0 5 <br /> PROPERTY OWNER/OPERATOR <br /> AME Sunboro Develo 1 HONE <br /> DRESS 1307 South Mary, Suite 208' � <br /> ITY Sunnyvale TATE IP 40 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> ME Same as owner HONE �. <br /> DRESS <br /> ITY TATE IP <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> i, 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 RESULT, GEOTECHNICAL DATA AHD/OR EMVIRONMENTAL/SITE ASSESSMENT INFORMA' -4 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTIL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME , <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br />�.x�e".-:r a•. -.`'-"'e' :'.:,,.rw-�r.r+�.aw..�;�..'�-_.�-.,-a.r:�-= „rr- - - � - ,. _ -. -.. _._..T _-_ _. <br /> ADDITIONALLY, E, THE UNDERSIGNED OWNER, OPERATOR, CLIEI1, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE AND/CR PROstCT'SP- <br /> PH$/END HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE 9, <br /> APPLICANT'S NAME, TITLE, SIG TORE/DATE <br /> AME Rand. Hess, Adleson, Hess, Christensen & Kell <br /> !I <br /> DATE March 1991 <br /> rrLE Attorn at Law -! <br /> i 89-007(IV)12/90VILFRM12 <br /> r Vis' <br />