Laserfiche WebLink
. R �V5992421 'raE:;rE r:Prl 41 01 <br /> 51 MITIGATION ACKNwtEDGH£RT/REQUEST FOR SERVICES FORA <br /> $lit INFCRMAT{GH <br /> SAN JOAOUIN C"TT - PUBLIC HEALTH SERVICES/ENVIRONNENTAL HEALTH DIVISION <br /> _ <br /> HER LEAD AGENCY RWQCB ..._-� <br /> 31T. NAME Ripon Sit(' <br /> AGENCY CONTACT I CaM Williams <br /> PHONE <br /> oR ss Vicinity of Industrial Avenue (916 381-5600_ <br /> ITY Ripon, CA <br /> BILLING / HtSP{1151BLE PARTY INFORMATION <br /> AME N�ytle Beveragr Co. P3 tze'13- <br /> Sys l4� <br /> (LING ADDRESS _230 Indenue <br /> i i Y Ripon -il�. Av .. <br /> OS v vsc, &A TATE CA 1P 95366 <br /> . � <br /> NTACT NAME HOME 3 Y _ 3 '1yb <br /> I <br /> PROPERTY OWNER/OPERATOR <br /> ANENestle NONE <br /> DRESS 830 Industrial Avenue <br /> i ITY Ripon TATE CA kIP 1 95366 <br /> CLIENT INFORMATION (IF DIFFERENT FROM TAMER/OPERATOR) <br /> AME HONE <br /> DRESS <br /> TTY TATE IP <br /> AUTHOR12ATION TO RELEASE/BILLING ACKNOWLCOCE14ENT <br /> 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OT AGENT OF SAME, OF THE PROPERTY LOCATED AT THE ABOVE SITE ADORES$ 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 15 <br /> PROVIDED TO NE 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 /> I ME4Ese <br /> ltng str 569-68-6576 <br /> IONATURE ATE 11�61�91 <br /> CMPANTer pang InEPlant Engineer <br /> �.r':.:a.^ - ..__._.�«�„a •-."^;,=eve•�in" fi4.�r,�s7w"`y�`o' ��I'"6�`.�,N�ciY'^°iir=''� .. <br /> 4 ftp <br />