Laserfiche WebLink
h ' MITIGATION ACKNOWLEDGMENT/REQUEST FOR SE FORM I <br /> SAN JOA6—.. COUNTY • PUBLIC HEALTH SERVICES/ENVIRONMEti,__ LEALTH DIVISION <br /> SITE INFORMATION <br /> THEIR LEAD AGENCY N/A <br /> 1 <br /> SITE NAME Southern Pacific Transportation AGENCY CONTACT <br /> Company Yard <br /> PHONE <br /> DDRESS 780 E. Sixth Street APN !! 235-150-09 , 02 , 12 , 14 <br /> L <br /> Y Tracy, California ZIP 95376 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Braddock and Logan Associates <br /> AILING ADDRESS 4155 Blackhawk Plaza Circle , Suite #201 <br /> 17 Danville, STATE CA IP 94526-4668 <br /> ONTACT NAME <br /> Jeff Lawrence HONE (415 ) 736-4000 <br /> PROPERTY OWNER/OPERATOR <br /> AME Southern Pacific Transportation Company 1PHONE 1 ( 415 ) 591-2665 <br /> DDRESS 1 Market Plaza <br /> ITY San Francisco ISTATE I CA IP 1 94105 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> SAME Same as RP HONE <br /> DDRESS <br /> ITY ISTATE1 IP <br /> AUTHORIZATION 10 RELEASE/BILLING ACKNOWLEDGEMENT <br /> I, 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, 1, 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 John A. Ba er Stt <br /> i <br /> SIGNATURE ATE 10/31/91 <br /> OMPANY A er on Cons ing Group ITLE Directogr��,yEn[v�ironmental Division <br /> PA i MGN 1, <br /> *EIV ''� <br /> 89.007(IV)12/9 /LFRM12 NO v n b :-T4 <br /> EH 29 01 S! <br /> �!OAQUtN COUNTY <br /> 4 !0 HEALTH SERVICES <br /> HEAT H DIVISV-1 <br />