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SIT TI WTION ACKNOWLEDGMENT/REQUEST FOR SERV1EE <br /> SAN JOAQUIN TY • PUBLIC HEALTH SERVICES/ENVIRONMENTAL TH DIVISION <br /> SITE INFORMATION <br /> THER LEAD AGENCY <br /> ITE NAME Southern Pacific Transportation Company Property AGENCY CONTACT <br /> PHONE I <br /> DRESS 780 E. Sixth Street APG 0 <br /> ITY Tracy IP 95376 <br /> i <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Industrial Compliance <br /> (LING ADDRESS 9719 Lincoln Village Drive, Suite 310 <br /> TY Sacramento STATE CA �ip975827 <br /> ONTACT NAME Mark S. Dockum, C. E.C. HONE (916) 369-8971 <br /> PROPERTY OWNER/OPERATOR <br /> AME Southern Pacific Transportation Company 1PHONE 1 (415) 541-1769 <br /> oDRESS One Market Plaza <br /> ,TY San Francisco TATE CA IP 94105 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME 1PHONE <br /> DDRESS <br /> i <br /> ITY TATE IP <br /> Z�s� <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, OF THE PROPERTY LOCATED AT THE ABOVE SITE ADDRESS HEREBY <br /> AUTHORIZE THE RELEASE OF ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO <br /> SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> ADDITIONALLY, I, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE AND/OR PROJECT SPECIFIC <br /> PHS/EHD HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> APPLICANT'S NAME, TITLE, SIGNATURE/DATE <br /> AME _,Mark,,7—,-. kum, E. [So <br /> IGNATUR /.j' ATE <br /> OMPANyi oft <br /> Iri�ustrial om iance [ITLE Project M r <br /> y Ya1F <br /> AL L 9 1992 <br /> 89-007(IV)12/90BILFRMI2 E.NVIRONMENTAU HEALTH <br /> EH 29 01 <br /> PERMIT/SERVICES <br />