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C�evmn <br /> August 4, 1995 v Chevron <br /> Occupant <br /> 570 N. Forest Hills Dr. <br /> Tracy, CA 95376 Chevron Pipe tine Company <br /> 4000 Executive Parkway,Suite 400 <br /> San Ramon, <br /> Alden Park Area P.O.Box 5059 A 94583 <br /> Owner/Occupant Consent Form San Ramon,CA 94583-0959 <br /> Backyard Soil Sampling <br /> Subject Property: 570 N. Forest Hills Dr.,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 /> i�� dl&4� <br /> Don O. Culbertson <br /> Are you the owner of the subject property? Yes No <br /> CON NT:f - <br /> ✓. <br /> (Sign ure) <br /> (Name - Please Print) <br /> Date: `�r/ ` `z / <br /> Home Phone Work Phone'1����, 7 > '�Y IsIc— <br /> Al reverso hay una version en Espanol. <br /> i <br />