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• SERVICE REQUEST <br /> Type Of Business Or Property FACILITY ID# Service Request# <br /> Agricultural/Residential(Present) 0 <br /> OWNER/OPERATOR Billing Party <br /> Mary Pombo, Ernest J. Pombo Jr.and Damon Pombo(Owner)/Bright Development(applicant) <br /> FACILITY NAME <br /> 24832 Lammers Road. <br /> SITE ADDRESS 24832 South Lammers Road. <br /> STREET# DIRECTION STREET NAME TYPE SUITE# <br /> MAILING ADDRESS(IF DIFFERENT FROM SITE ADDRESS) <br /> 1620 N. Carpenter <br /> CITY STATE ZIP <br /> Modesto CA 95354 <br /> PHONE#t EXT# APN# LAND USE APPLICATION# <br /> (209-) 526 8242 240-040-02 <br /> PHONE#2 EXT# BOS DISTRICT LOCATION CODE <br /> CONTRACTOR/SERVICE REQUESTOR <br /> REQUESTOR BILLING PARTY❑ <br /> Cele Underwood <br /> BUSINESS NAME PHONE# <br /> Thompson II sell, Inc. 209-251-8986 <br /> MAILING ADDRESS FAX# <br /> 1016 12th Sheet 209-521-9045 <br /> CITY STATE ZIP <br /> Modesto CA 95354 <br /> BILLING ACKNOWLEDGEMENT:I,the undersigned property or business owner,operator or authorized agent of same,acknowledge that all site and/or project specific public <br /> health services environmental heath division hourly charges associated with this project or activity wig be billed to me or my business as identical on this form. <br /> I also certify that I have preps d is application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY ORDINANCE CODES.STANDARDS,STATE <br /> AND FEDERAL LAWS. <br /> APPLICANT SIGNATURE: DATE:AP 30 1999 <br /> Cele Underwood <br /> PROPERTY/BUSINESS OWNER❑ OPERATOR/MANAGER❑ OTHER AUTHORIZED AGENT® 'I'll Inc. Project Manager <br /> TITLE <br /> It Applicant is not the Billing Party proof of authorization to sign is required <br /> AUTHORIZATION TO RELEASE INFORMATION:When applicable:I,the owner or operator of the property located at the above site address.hereby authorize the release any <br /> and all results geotechnical data and/or environmental/site assessment Information to the SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon <br /> as it is available and at the same time it is provided to me or my representative. <br /> TYPE OF SERVICE REQUESTED: <br /> Surface and subsurface contamination report 74 7^--',; <br /> COMMENTS - y <br /> We request the review of the attached S&S C. Report. It is our understanding that this review is r q'ilre l htl'rlr'e San <br /> .Joaquin County can accept the submittal of a tentative parcel map. nY 6 -, <br /> I'11R.SUAN7'TO C11AP7'ER 9-90-5.12 OF TIIF.DE1'ELOPAIE'T 777-L OFSAN J0AQ1;1A'CnuN7'r, <br /> SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SEnVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> INSPECTOR'S SIGNATURE: CONTRACTOR'S SIGNATURE-- <br /> APPROVED BY: p EMPLOYEE#: /r}C DLT (, <br /> ASSIGNED TO: EMPLOYEE# (r DATE. r <br /> DATE SERVICE COMPLETED(IF ALREADY COMPLETED): SERVICE CODE: 6 <br /> FEE AMOUNT.: 1 / AMOUNT PAID PAYMENT DATE`E — <br /> PAYMENT TYPE V fal 1 1 INVOICE# CHECK 9t. 'IV BY: <br />