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07/14/2009 TUE 12: 24 FAX <br /> 2aaz/aoz <br /> I <br /> i <br /> SAN JOAQUIN COUNTYENVIRONI► MAL JUALTH DER`.A.[tTMtNT <br /> SERVICE-REQUEST <br /> Type of Business of Propedy 1=AClL17Y IQ# SEIMCE REQUEST 9 � <br /> i <br /> moblle.homa pprk a C7 <br /> OWNER I OPERATOR <br /> Newportracific;apical Company,Acampo Arbor Limited C/�6C1LI�.t3lLLINYd.AD6RF5S <br /> FAC"17Y NA4�.The Arbr Mobile Horne Pari j <br /> srr�Amus <br /> 198A8 if H1gtlway Acampo 022 <br /> �}olwE er MAIGIIVG kDDRESs {1f Ditfie�nl from 31teAddrasal 17300 iced kill Ave.,#280 <br /> S of Nare�ber N <br /> CITY Irvine STATE CA 734 92614 <br /> fHDI>£tl9 EtR. A"0 LAND UsmAPPEJCA7MW0 <br /> �4B ► _ 5 {117-330-07 R -0980098 <br /> PHQRF,#2, SGS CasnwT LocomON Com <br /> i <br /> CONTRACTOR r SERVICI REQUESTOR <br /> ReQuES1't7R C W CK if 8aLIN GI ADDW.AS 1 <br /> Akhy.Racco <br /> 13us[N1�91VAME 4 pimE# xr• i <br /> Live Oak 9oobvironum0l,Inc. 369. 375 I <br /> Home orMAwNo ADDRESS FAX-9 s <br /> 407 W.Qak.Stw 75 <br /> Ci v Lodi STA-M 0A zip95240 <br /> BTILrPTG ACKNOWLEXIC MENT: L the undersiga @d pyep" or business owner, operator or aothorind agent of same, <br /> ftcknowfedge that all site and/or pro*t.specific f:JNvmL oNmENTAL 14EA1 TH 1)t3PA1tTme4`I'hourly ohargea asaecisted with this project <br /> ar ac'tivxty will be blued to me or my buAnm as identifier/on this form. <br /> I oleo certify that I have prepamd.tbls application and.tbat the work to.be pedermed,will be done l i accordanca with all SAN JQAQW <br /> cm,%r("l t7r nance Codes,S'tandwd4r,STATE and FEDERAL taws. <br /> APPL1CAMT1S SIGNATMW' irA i <br /> ft40j%RTV BUSINESS O►vNER13 �O EAA70RI MOACER-W CrrlHlp.RAUTnaa1rW.A00NT,0 <br /> 1jAppLjcAjvTUnot1haAU4MEa p o of of J1uthorizurionLv sign b tt"irtd Tithe <br /> AEJTA F4M When applicable,.1, the owner or,xrptioWr of 1hce property locawd at the i <br /> above We address, hereby Etutlmiae the release of my and all.results, geotechnical data and/or envirownental/site 990991meyt <br /> lnformaion to the SAN J..OAQLgN COt1NTY ENMOMAENTAL HeALMI AF.PA.ItTMCKT 68 soon as it is avaslaGle aud.at ft-Saltie thele It is <br /> prgvlded to me or nay repirwtativo. <br /> TYPE OF SERVICE REQLW1=: 9 I <br /> PAYMENT E <br /> Comm RECEIVED I <br /> Plead review the a6ge report. A report review tie of$210 is attached. <br /> / JUL 14 2009 j <br /> �� i JOAQUIN COUNTY Ii <br /> EIMRONMENTAL I <br /> APPROWD 6Y: F- �G�G EAIIPLAT r'YY: 3 DATE I <br /> k <br /> AssaQWQTn: A EmKoYEE#: S36,6� DAM <br /> Date Service Complatad (If alrsa*mrnptv#ed), $ERtiACE C� P l E: <br /> Fee Amount: Zl v Arnuurrt Paid , v Paymelat 7WT <br /> Patmlerti'ypa G' It�vaica# Ch"X* Received. <br /> EHL)48-01425 SERVICE REQ S7 FOIA <br /> REVISED 8•&02 <br />