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SIT 'TIGATION ACKNOWLEDGMENT/REQUEST FOR SERVIC ! ORM <br /> S'iTE INFORMATION SAN JOAQUIN`�__.JNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL-:-,1LTH DIVISION <br /> THER LEAD AGENCY <br /> ITE NAME Not Applicable AGENCY CONTACT <br /> PHONE <br /> DRESS 950 Industrial Drive APN 9 <br /> [TYStockton EP 95215 <br /> BILLING / INFORMATION <br /> AHE Levine-Fricke <br /> IL[NG ADDRESS 1900 Powell Street /12th Floor <br /> ITY Emeryville TATE CA 1p 94608 <br /> ONTACT NAME Kathleen Isaacson, R.G. HONE (510) 652-4500 <br /> PROPERTY OWNER/OPERATOR <br /> AME Marian Mohr Fry 1PHONE 1 (209) 334-38-08 <br /> DRESS c/o Jeryl Fry, Mohr-Fry Ranches/12609 North West Lane <br /> ITY Lodf TATE CA Ip 95240 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AHE Not Applicable 1PHONE <br /> DORESS <br /> ITY TATE IP <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, 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE ANO/OR PROJECT SPECIFIC <br /> PMS/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 /> AME Kathleen Isaacson, R.G [Sid S�a.S, — (a (4 3055 <br /> tGNATURE ��`�/l� l AE 5/9Z <br /> OMPANY Levine-Fricke IT ITLE Senior Hydrogeologist <br /> J <br /> 89-007(IV)12/908[LFRM12 rt S V <br /> lJ ^� <br />