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California kgional Water Quality COrol Board <br /> Central Valley Region ' <br /> Katherine Hart, Chair ~, <br /> Linda S.Adams Arnold <br /> Secreiaryfor 11020 Sun Center Drive#200, Rancho Cordova, California 95670-6114 Schwarzenegger <br /> Environmental Phone(916)464-3291 •FAX(916)464-4645 Governor <br /> Protection http://www.waterboards.ca.gov/centraIvaIley <br /> ACKNOWLEDGMENT OF RECEIPT OF <br /> OVERSIGHT COST REIMBURSEMENT ACCOUNT LETTER <br /> I, acting within the authority vested in me <br /> as an authorized representative of <br /> a corporation, acknowledge that I have <br /> received and read a copy of the attached REIMBURSEMENT PROCESS FOR <br /> REGULATORY OVERSIGHT and the cover letter dated 20 September 2010 concerning cost <br /> reimbursement for Regional Water Board staff costs involved with oversight of cleanup and <br /> abatement efforts at 401 North San Jose Street in Stockton, San Joaquin County. <br /> understand the reimbursement process and billing procedures as explained in the letter. Our <br /> company is willing to participate in the cost recovery program and pay all subsequent billings <br /> in accordance with the terms in your letter and its attachments, and to the extent required by <br /> law. I also understand that signing this form does not constitute any admission of liability, but <br /> rather only an intent to pay for costs associated with oversight, as set forth above, and to the <br /> extent required by law. Billings for payment of oversight costs should be mailed to the <br /> following individual and address: <br /> BILLING CONTACT <br /> BILLING ADDRESS <br /> TELEPHONE NO. <br /> RESPONSIBLE PARTY'S SIGNATURE <br /> (Signature) <br /> (Title) <br /> DATE: <br /> Return to the attention of <br /> Roberto Cervantes <br /> California Environmental Protection Agency <br /> �a Recycled Paper <br />