Laserfiche WebLink
LAW QFFICE <br /> P- 42 <br /> SITE HITIOATIaN OR STATEMENT ACKNOWUDGW42NT/REQUEST tort SERVICES <br /> LEER OF A4` NOWLSOGMUM 4 <br /> Tot SAN JOAQUXN COUNTY PUBLIC REA14TH StRIVICES <br /> MMIROWMAL HEALTH DIVISION (PHS -an) <br /> 4 4 5 X. SAN aCAQnIN ST. <br /> P. b+ Bax 2009 <br /> STOMOR r CA 93201 <br /> c ROM: ESTATE•DE JOSEPWG. .LLA, SRd <br /> (pzgpar Y owner name <br /> JOM At tz", AmiN i STMTOR 5 8676 <br /> (owner m4iling A, loess) <br /> P-0. Box 7W, C,/0 DENN I a CW E,, ,SANTA CFWZ, CAL i F'ORN IA 9W <br /> (City, stage, ) <br /> Gi e <br /> (Ato dress <br /> J(We) declAre that the activity being porfarmad at the above <br /> refarenced site is being conducted ' with, my(aur) know)-ede�e and <br /> approval. Furthermorm, i(we) acknowledge :that payment of 15119-M <br /> chaxjea will bectPme my(aur) responsibility in the event xftid <br /> charges are not paid by the client and/or operator ident1fiod an <br /> the attached "Site Nitigation Agknowledgezent/ReVeet for Servic$s <br /> Form" or the "Statement AcXA6W #-djem0-nt/'9*gV9et for Sorvicas fame" . <br /> (e g e►ran a (P ona number <br /> care) <br /> I <br />{ <br /> 7 <br /> 4 <br /> LC`ACKN. PRM ' <br />