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• • 23`x- odd— z/ <br /> /A <br /> August 4, 1995 Chevron <br /> Chevron <br /> Simon J. &L. V. Ramirez <br /> 788 N. Sequoia Blvd. <br /> Tracy, CA 95376 Chevron Pipe Line Company <br /> 4000 Executive Parkway,Suite 400 <br /> San Ramon,CA 94583 <br /> Alden Park Area P.O.Box 5059 <br /> Owner/Occupant Consent Form San Ramon,CA 94583-0959 <br /> Backyard Soil Sampling <br /> Subject Praperty: 788 N. Sequoia Blvd., Tracy, CA <br /> Dear Owner/Occupant: <br /> Chevron is conducting a soil investigation in the vicinity of your residence. As part of this study, <br /> Chevron would like your permission to obtain a soil sample from your property. <br /> Chevron has selected an independent contractor, Geomatrix Consultants, Inc., to perform the soil <br /> sampling. In the unexpected event that your yard or other property is damaged by the contractor, <br /> Chevron will assume responsibility for correcting the damage. <br /> If you consent to Chevron entering your property to perform this work, please sign and date this <br /> letter on the line below. Please include your phone numbers so that Chevron can contact you to <br /> schedule a date and time to perform the work. We greatly appreciate your cooperation in this <br /> matter. <br /> Sincerely, <br /> Don O. Culbertson <br /> Are you the owner of the subject property? Yes ✓ No <br /> CONSENT: <br /> ( ignnatu"re) <br /> (Name - Please Print) <br /> Date: <br /> Home Phone: �' 1 `// Work Phone: /LSF <br /> Al reverso hay una version en Espanol. <br />