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0 <br /> Proposed location for subsurface work: <br /> Property Address: Assessor's Parcel Number(APN): <br /> 24560 Schulte Road 209-440-35 <br /> Tracy, CA 95377 <br /> I, owner of the property/properties listed above,give my permission to <br /> Stantec Consulting Services, Inc. (consulting company, contractor)to conduct the following work at the locations <br /> stated above. <br /> Install monitoring wells Destroy monitoring wells ❑ Drill 11 soil borings <br /> I understand that Amanda Magee(registered professional)of Stantec Consulting Services Inc. (consulting company)and an <br /> authorized signer for Gregg Drilling Inc. (drilling company) have submitted a signed application to the <br /> Department of Environmental Health in which they have agreed to complete the above-stated work according the requirements <br /> of the State of California pertaining to well/boring construction and destruction. I have arranged with the Responsible <br /> Party, the person who causes to have borings installed on this property, to ensure proper closure of the monitoring <br /> wells/borings. /� <br /> Property Owner Signature: <br /> 1 p Date: 8'Q2 <br /> W -2U1�1 <br /> Print Name: �' b �� ��e[[e6-e- Title: COC.V1� <br /> Company: -I- Lk 5VV�iC/L <br /> Mailing Address: 4 66 6 sou,�A yJ lU A Sat t�f r L/ �i 53 6� <br />