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�6Z <br /> Chevron <br /> Chevron <br /> August 17, 1995 <br /> Chevron Pipe Line Company <br /> 4000 Executive Parkway,Suite 400 <br /> San Ramon,CA 94583 <br /> Alden Park Area P.O.Box 5059 <br /> San Ramon,CA 94583-0959 <br /> Owner/Resident Consent Form <br /> Backyard Soil Sampling <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. yy <br /> Property Address: tyl�an rn reS FFr I5 <br /> Are you the owner of the subject property? Yes / No <br /> CONSENT: <br /> (Signature) <br /> r ,gP,K d4 bgW <br /> (Name -Please Print) <br /> Date: I- :2a- - 95- <br /> Home <br /> 75Home Phone: E 32 - J-I 72 Work Phone: `6 3 3 —15' 3 <br /> Al reverso hay una version en Espanol. <br />