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05-18-1995 09 : 18819 FRW TO 5274810 P . 02 <br /> F ' � _ . �_ <br /> 351 MAY 30 AM 11 ; 20 <br /> i <br /> SITE MYTIGATION PROGRAM <br /> BIL . I,ETTT,` . OF ACXNOWLEDGEMENT : <br /> TO : ' ' SAK [ JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION ( PISS -EHD ) <br /> 445 � N . SAN JOAQUIN ST . <br /> P . 0F, BOX 2009 <br /> STOCATON , CA 95201 <br /> i <br /> FI20M : 1 E� <br /> ( property owner name ) <br /> ZZ d�, ,� /,vimy <br /> ( owner mailing a dress ) <br /> ( city , state , 'LIP ) <br /> k RE : S( Site address ) <br /> i <br /> I ( we ) declare that the assessment activity being performed , at the <br /> above. referenced site is being conducted with my ( our ) knowledge and <br /> approval .. Furthermore , I ( we ) acknowledge ' t'hat payment of PHS - EHD <br /> charges. . . will become my ( our ) responsibility in the event said <br /> chargesare not paid by the client and / or operator identified on <br /> "Gene_ , l pkv"Fr m � ii2 . <br /> f (signature and title ) ( phone number ) <br /> ( date ) <br /> LC \ B,ILACKN . FRM <br /> i <br />