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SITE INFORMATION THER Luta h.crvLY <br /> ITE NAMESite 300, Lawrence Evermore National Laboratory A ' CONTACT <br /> PHONE <br /> APN # <br /> DDRESS Corral Hollow Road <br /> IP <br /> tTY Tracy, California <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Lawrence Livermore National Laboratory <br /> AILING ADDRESS P.O. Box 808, L-528 <br /> ITY Livermore TATE ::CA:::PIF 94550 <br /> 'ONTACT NAME Albert L. Lamarre HONE (415) 422-0757 <br /> PROPERTY OWNER/DMA.L01 <br /> AMEHONE (415) 422-0757 <br /> Lawrence Livermore Nation <br /> DDRESS P.O. Box 808 <br /> [P <br /> [TY Livermore TATE CA <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> IIONE <br /> AME <br /> DDRESS <br /> TATE IP <br /> ITY <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, I, 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 /> LAME Fredric Hoffman S# <br /> IINATURE <br /> Division Leader for <br /> OMPANY Lawrence Livermore National Laboratory TITLE Environmental Restoration <br /> 89-007(lV)12/90BILFRMI2 0� G/ A U G 2 p 1;1;�l <br /> SAN JOAQUIN COUNT Y <br /> PUBLIC HEAiCH SES"•`�C S <br /> = :ViR �NMENTAL H ,al_TH L�iV!4 <br />