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SIT*GATION AC"CWLEDGMENT/REQUEST FOR SERVICE& <br /> SITE INFORMATION SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> THER LEAD AGENCY Cal-EPA:Toxic SuhS ance <br /> ITE NAME PG&E - ManufacturEGasPlantSite AGENCY CONTACT troFernando AmadorPHONE 916-855-7892DRESS APN #535 South Center <br /> ITY Stockton IP <br /> 95201 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Pacific Gas & Electric, Environmental ServigDepartMent(LING ADDRESS P.O.Box 7640 <br /> ITY San Francisco IP 94120ONTACT NAME Yvonne Meeks 2-1116 <br /> PROPERTY OWNER/OPERATOR <br /> AME Pacific Gas & Electric HONE 415-973-7000 <br /> DRE" 77 Beale Street <br /> ITY San Francisco <br /> TATE CA IP 94106 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) SECOND PROPERTY OWNER <br /> "I. <br /> aint Company HONE <br /> Sonora Street 209-466-4541 <br /> TATE I CA IP 95201 <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.WILL3E,8I LLED..TO.THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> APPLICANTOS NAME, TITLE, SIGNATURE/DATE <br /> LAME Victor IC. Furtado - _ . <br /> S# <br /> IGNATURE q <br /> ATE <br /> MIPANY Pacific Gas & lectric Company ITLEManager, Environmental Srvs Dept. <br /> 89-007(IV)12/90BILFRM12 ( �� <br />