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y <br /> Chevron <br /> August 4, 1995 , Chevron <br /> Guadalupe A. &G. Cebreros <br /> 455 N. Palm Circle <br /> Tracy, CA 95376 Chevron Pipe Line Company <br /> 4000 Executive Parkway,Suite 400 <br /> San Ramon,CA 94583 <br /> Alden Park Area Po.Box 5059 <br /> Owner/Occupant Consent Form San Raman,CA 94583-0959 <br /> Backyard Soil Sampling <br /> Subject Property: 455 N.Palm Circle,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 /> on O. Culbertson <br /> Are you the owner of the subject property? Yes 7'�-- No <br /> CONSENT: / <br /> t <br /> (Signature) <br /> �a( f/ //E Zn(i qc,- — tlZQls � <br /> (Name -Please Print) <br /> Date: R -)-a 4 b <br /> Home Phone: 10 5 )'2 .3 Work Phone: <br /> A] reverso hay una version en Espanol. <br />