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TO: RUSS MATTHEWSON <br /> COMPANY: PETROCON <br /> FAX: 805 938-02-W4/1 pt 5 <br /> VOICE: 805 938-1a 7�' a�S'J� <br /> FROM: STEVE SASSON <br /> COMPANY: SAN JOAQUIN COUNTY, ENVIRONMENTAL HEALTH DIVISION <br /> FAX: 209 468-3433 <br /> VOICE: 209 468-3459 <br /> RE: STOCKTON DEVELOPMENTAL CENTER <br /> 510 E MAGNOLIA ST, STOCKTON <br /> Russ <br /> Your company is not on our list of qualified consultants. Please complete the '. <br /> contractor/consultant questionnaire including the consulting firm information. You also <br /> need to complete the workers compensation waiver or if you have employees you <br /> need to send us a copy of your policy. We also need a copy of your pocket <br /> contractors license. <br /> am sending you a copy of the Masterfile Record Information Form. The owner <br /> information section should be completed as the California Division of the State <br /> Architect. The facility name is the Stockton Developmental Center. Mailing Address is <br /> the DSA office. The third party billing information should also reflect the DSA office. <br /> I <br /> am sending you a copy of the Service Request Form. The information on this form <br /> should reflect the same information as the Masterfile Record Information Form for <br /> facility name and owner/operator. The Contractor is you or your company A <br /> signature on this form will authorize our department to bill the DSA as the third party <br /> payee. PHS/EHD requires a signature by Miike Golden or another authorized person <br /> from the DSA office on this form. <br /> The initial fee for the in place tank-closure and the sump and pipeline closure is <br /> $234.00. The signature on the Service Request form authorizes this agency to bill the <br /> third party payee additional charges for the tank closure at an hourly rate of $78.00. <br /> i <br /> If you have any questions please call me. <br /> Gooq Luck <br /> Steve Sasson, REHS <br />