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SITE TION ACKNOWLEDGMENT/REQUEST FOR SERVICES <br /> SAN JOAQUIN C Y - PUBLIC HEALTH SERVICES/ENVIRONMENTAL DIVISION <br /> SITE INFORMATION <br /> HER LEAD AGENCY DHS <br /> [TE NAME AGENCY CONTACT JIM AUSTRENG <br /> MARLEY COOLING TOWER COMPANY (1 16) 855-7857 <br /> PHONE <br /> DRESS APN # <br /> 150 N. SINCLAIR AVE. <br /> ITY IF <br /> STOCKTON , CA 95205 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME MARLEY COOLING TOWER COMPANY <br /> (LING ADDRESS 5800 FOXRIDGE DRIVE <br /> ITY MISSION TATE KS Ir 66202 <br /> MARLEY 74151 <br /> THE MARLEY COOLING TOWER COMPANY 80.1823 <br /> A MARLEY COMPANY 1019 <br /> 5800 FOXRIDGE DRIVE—P.O.BOX 2912 MAR 28 1991 <br /> MISSION,KANSAS 66201 `n <br /> z� 'i!E-`-4'` j 9dr�I.II�0Oct $159.00 <br /> J <br /> TO THE ORDER OF *San Joaquin County Public Health ServiCeTHE MARLEY COOLING TOWER COMPANY <br /> 1601 East Hazelton Avenue <br /> Stockton, CA 95201 <br /> BOATMEN'S NATIONAL BANK OF BOONVILLE,MISSOURI <br /> 112074i5Lill I: 10 19 18 2371: 40010070008811' <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 /> IGNATURE <br /> ITLE CHIEF PRODUCTION ENGINEER DATE March 28, 1991 <br /> PAGE ONE OF TWO <br /> 89-007(IV)12/90BILFRMI2 <br />