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SITE M TIGATION AC"' OWLEDGMENT/REQUEST FOR 'SERVICES(ORM <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION <br /> OTHER LEAD AGENCY Cal-EPA:Toxic Subs anc <br /> tro <br /> ITE NAME AGENCY CONTACT Fernando Amador <br /> PG&E - Manufactured Gas Plant Site <br /> PHONE 916-855-7892 <br /> DRESS 535 South Center Street APN # <br /> ITY IP <br /> Stockton 1Z 1 95201 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Pacific Gas & Electric, Environmental Services Department <br /> !LING ADDRESS P.O.BOX 7640 . <br /> ITY San Francisco TATE CA IP 94120 <br /> ONTACT NAVE Yvonne Meeks HONE 415-972-1116 <br /> PROPERTY OWNER/OPERATOR <br /> AME Pacific Gas & Electric HONE 415-973-7000 <br /> DRESS 77 Beale Street <br /> ITY San Francisco TaTE CA IP 94106 <br /> CLIENT INFORMATION (IF DIFFERENT FROM 0WNER/OPERATOR) SECOND PROPERTY OWNER <br /> ME Morton Paint Company HONE 209-466-4541 <br /> DRESS 38 West Sonora Street <br /> Iry Stockton ISTATE I CA IF 95201 <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/EHO 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 /> 1AME Victor Furtad0 <br /> ICNATURE ATE <br /> MPANY Pacific Gas & lectric Company ITLE Manager, Environmental STvs Dept. <br /> 89-007(IV)12/90BILFRMI2 <br />