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SIT�IGATION ACKNOWLEDGMENT/REQUEST FOR SERVICORM <br /> SAN JOAQUIN NTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL TH DIVISION <br /> SITE INFORMATION THER LEAD AGENCY RWQCB <br /> ITE NAME Shell Oil Distribution Facility AGENCY CONTACT Antonia Vorster <br /> PHONE (916) 361-5647 <br /> DRESS 3515 Navy Drive APN # <br /> ITY Stockton IF, 95203 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Mr. Ron S. Jack, Shell Oil Company <br /> AILING ADDRESS 511 North Brookhurst Street <br /> Anaheim 3TATE CA IP 92803 <br /> ITY <br /> oNTACT NAME Mr. Ron S. Jack PHONE (800) 447-4355 <br /> PROPERTY OWNER/OPERATOR <br /> AME Shell Oil Company HONE 1 (209) 466-6941 <br /> %DDRESS Navy Drive <br /> ITY Stockton TATE I CA kIP 1 95203 <br /> CLIENT INFORMATION (IF DIFFERENT FRC14 OWNER/OPERATOR) <br /> AME same HONE <br /> ODRESS <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 ASSESSMENT 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, 1, 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 /> TAME <br /> Daniel J. Craig (as agent for Shell) <br /> ICNATURE / ' ATE -7-02- 19011 <br /> oMPaNr Harding-Lawson Associates TITLE Senior Hydrogeologist <br /> 89-007(IV)12/90BILFRM12 <br /> L - <br />