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r <br /> SITE MITIGATION PROGRX4 <br /> BILLING LETTER OF ACKNOWLEDGEMENT: <br /> TO: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br /> 445 N. SAN JOAQUIN ST. <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95201 <br />.�^-"--titer,_ �.... ys __-..,_�"-t... •+�. �---` b�� ---wti.�....� �"-��.-�' .•-- __ _,. .��.+,�f': ..: �_�... -.. ..i <br /> FROM: <br /> (p operty owner name) <br /> (dwner mailing address) <br /> <IkAz ��M, 6 <br /> (city, 6tate, ZIP) <br /> RE: / <br /> ' (site address) <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 <br /> 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 Seri es <br /> For <br /> ._ _ �: y.. _ ...:�-may„;•- .�...�- . .. -"`"'.,,..F,� - _ _ ��. �- .-.,. <br /> (signature and title) (phone number) <br /> date) �Y�✓'�4�'9 <br /> LC\BILACKN.FRM <br /> 'Jy <br />