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SITE�GATION ACKNOWLEDGMENT/REQUEST FOR SERVICES M <br /> SAN JOAQUIN Y - PUBLIC HEALTH SERVICES/ENVIRONMENTAL N { DIVISION <br /> SITE INFORMATION . <br /> THER LEAD AGENCY DHS <br /> RNAME AGENCY CONTACT JIM AUSTRENG <br /> EMARLEY <br /> OWER COMPANY <br /> PHONE (916) 855-7857 <br /> APN N <br /> AVE. <br /> tP <br /> STOCKTON, CA 95205 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME MARLEY COOLING TOWER COMPANY <br /> (LING ADDRESS 5800 FOXRIDGE DRIVE{ <br /> ITY MISSION 3TATE KS IzIp 66202 <br /> NTACT NAME MR. DAVID W. BATES HONE (913) 362-1818 <br /> PROPERTY OWNER/OPERATOR <br /> iAME MARLEY COOLING TOWER COMPANY - HONE (91 3) 362-1818 <br /> DRESS 5800 FOXRIDGE DRIVE <br /> ITYMISSION TATE KS kIP 166202 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME ` Vii; - HONE <br /> DRESS <br /> ITY TATE IP <br /> i <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 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 /> 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 DAVID W. BATES <br /> IGRATURE <br /> TITLE CHIEF PRODUCTION ENGINEER DATE March 28, 1991 <br /> PAGE ONE OF TWO Z �f Ady <br /> 89-007(IV)12/90BILFRMI2 Lw) 1>"l <br />