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SIT.-;�aTIGATION ACKNOWLEDGMENT/REQUEST FOR SERVICEt FORM <br /> SITE INFORMATION SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> THER LEAD AGENCY <br /> 31TE NAME Former Unocal Bulk Plant #0950 AGENCY CONTACT <br /> PHONE <br /> %DDRESS 2835 Navy Drive APN # 145-030-09 <br /> ITY Stockton <br /> IP <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Unocal Corporation <br /> (LING ADDRESS P. O. Boz 5155 <br /> ITY San 11=on TATE CA �Ip <br /> 94583 <br /> ONTACT NAME Mr. Keith Bullock HONE (510) 277-2321 <br /> PROPERTY OWNER/OPERATOR <br /> AME The Port of Stockton HONE <br /> DRESS ^ <br /> ITY lv4, ) ISTATEIP S j Z/j <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> aME Kaprealian Engineering, Inc. (Consultant) HONE 1 (510) 602-5100 <br /> DDRESS 2401 Stanwell Drive, Suite 400 <br /> !TY Concord ISTATE I CA IP 1 94520 <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT �,. .•:� <br /> 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, OF THE PROPERTY LOCATED iA,jjfH2 l6O1992TE ADDRESS HEREBY <br /> AUTHORIZE THE RELEASE OF ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR �FVqRVVjJ�iCTguU�(l�ifE?iA98ESSMENT INFORMATION TO <br /> IFA, <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON r$.I VZ aVAi�'6g4 A�o g -pp 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 /> 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 /> AME Tim Ross Pro'ect Manager / Agent S# <br /> IGNATUR ATE (P/d3 <br /> LOMPANYKAp realise Bn eerie Inc. ITLE Consultant <br /> 89-007(IV)12/9 'SILFRMI2 <br />