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FOR SERVICES*RM <br /> SITE MITIGATION ACKNOWLEDGMENT/REQUEST <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION yL <br /> THER LEAD AGENCY <br /> ITE NAME Holly Sugar Corporation AGENCY CONTACT <br /> PHONE <br /> DDRESS 20500 Holly Drive APN # <br /> ITY IP 95378 <br /> Tracy, CA <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Holly Sugar Corporation <br /> AILING ADDRESS P.O. BOX 60 <br /> ITY Tracy, TATE CA TIPT95378 <br /> ONTACT NAME Matthew G. Fenske HONE (209) 835-3210 <br /> PROPERTY OWNER/OPERATOR <br /> AME Imperial Holl Cor oration HONE <br /> DDRESS <br /> ITY TATE iP <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME HONE <br /> DDRESS <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 ASSESS14ENT 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 /> 'AME Ma e . Fenske s# <br /> I GNATURE ATE 10/21/92 <br /> Western Division <br /> OMPANY Imperial Holly Corp. ITLE Environmental Engineer <br /> 89-007(IV)12/90BILFRM12 <br />