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i <br /> SI'i fIGATION ACKNOWLEDGMENT/REQUEST FOR SERVIC. )RM <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION <br /> OTHER LEAD AGENCY <br /> ITE NAME AGENCY CONTACT <br /> Lots 9 and 10, Stonebridge Industrial Park <br /> PHONE <br /> DDRESS no street address APN # <br /> ITY Tracy, California IP <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Geomatrix Consultants <br /> AILING ADDRESS 2444 Main Street, Suite 215 <br /> ITY Fresno 3TATE CA IzIp 93721-2734 <br /> ONTACT NAME Jill Jefferson HONE (209) 264-2535 <br /> PROPERTY OWNER/OPERATOR <br /> AME O.K. and B. , c/o Mark III Engineering Contractors HONE 1 (916) 381-8080 <br /> DDRESS 5161 Florin-Perkins Road <br /> [TY Sacramento TATE I CA IP 1 95826 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> +AME United States Cold Storage HONE 1 (609) 354-8181 <br /> DDRESS P.O. box 5460 -� <br /> ITYCherry Hill TATE CA IP 08034-5460 <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 TISIE 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 AND/OR PROJECT SPECIFIC <br /> PNS/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 /> LAME Jill Jefferson [Sol 521-25-2021 <br /> r <br /> IGNATURE ATE 1 14 August 1991 <br /> [OMPANY /;CeomZ�Wi Consultants TITLE Senior Staff Geological Engineer <br /> 89-007(IV)12/90BILFRMI2 <br />