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6 <br /> i <br /> i <br /> I <br /> i <br /> SITE MITIGATION PROGRAM <br /> BILLING LETTER OF ACKNOWLEDGEMENT: { <br /> i <br /> TO: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> j ENVIRONMENTAL HEALTH DIVISION (PHSEHD) <br /> 445 N. SAN JOAQUIN ST. <br /> 3 P: O. BOX 2009 <br /> r STOCKTON, CA 95201 <br /> 1 , <br /> FROM: <br /> (property owner name) <br /> (owner mailing address) <br /> i <br /> (city, state, ZIP) i <br /> t <br /> RE: <br /> (site address) <br /> i <br /> e - <br /> I (We) declare that the assessment activity being performed at the <br /> above referenced site is being conducted with my(our) knowledge and <br /> approval. Furthermore, I(we) acknowledge that payment of PHS--EHD E <br /> i charges will become my(our) responsibility' in the event said <br /> charges are not paid by the client and/or operator identified on <br /> the attached "Site Mitigation Acknowledgement/Request for Services <br /> Form. " <br /> t <br /> (signature and title) ' (phone number) <br /> r <br /> } <br /> (date) <br /> LC\BILACKN.FRM <br /> } <br /> 77 <br /> - <br />