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• 1 <br /> SITE PIITIGATIO.`I ACKNOWLEDGMENT/REQUEST FOR SERVICEb-'ORI1 <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIROW4ENTAL HEALTH DIVISION <br /> SITE INFORMATION <br /> THER LEAD AGENCY CV-RWQCB <br /> ITE NAME PG Ag Products (Cargil Molasses) AGENCY CONTACT Wendy Wyles <br /> PHONE (916) 255-3104 <br /> oRESS 2130 West Washington Street APN # <br /> ITY Stockton ZIP <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Sierra-Pacific Groundwater Consultants, Inc. <br /> (LING ADDRESS 4911 Windplay Drive, Suite 4 <br /> ITY El Dorado Hills TATE CA IP 95762 <br /> ONTACT NAME John Rapp HONE (916) 933-1468 <br /> PROPERTY OWNER/OPERATOR <br /> AME Port of Stockton HONE 1 (209) 946-0246 <br /> DRESS P.O. BOX 2089 <br /> ITY Stockton TATE I CA IP 1 95201 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> LAME Unocal Corporation HONE (51 0) 277-2381 <br /> TDRESS 2000 Crow Canyon Place, Suite 400 <br /> 'I TY San Ramon TATE � IP 94583 <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT 50 <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 JOAQUIN 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 /> PNS/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 Steven Rapp, CEG-1133 k#1 551-68-3467 <br /> I GNATURE ATE 3 <br /> OMPANY I Sie Da-Pcific G oundwater Consultants, Inc. TITLE I Senior Engineering Geologist <br /> PAGE ONE OF TWO <br /> 89-007(IV)12/90BILFRMI2 <br /> EH 29 01 <br />