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04 <br /> •-- <br /> SERVICI AEOMIt . ON 00 61) Mvl/ed 6/23/93 <br /> FACILITY ID AECaaO ID a ' �- -- INVOICI / <br /> ass <br /> tllclllfY NAMB Van De Pol EirterprisesilLLING PM1T ' V / 6 <br /> #Ill ADDABf1 3230 N West Lane <br /> elty t Stockton, CA zip 95204 <br /> ' UN ti/oPINA1d1 Van De Pol Enterprises IIIIING PMtY m /` M <br /> DeA oNalt 11 1209 ) 4G6 5921 <br /> co- <br /> AODNIII P n Box 1107 <br /> elf? _,g_t_nPktnn STATE CA zip 95201-1107 <br /> A� �Lend Use MPI Icet lane <br /> BOs DNt Lol:etlen C <br /> CoNIAACICA AM/or <br /> eENVICB REtANtflolt Jim Thorpe Oil, Inc . BILLING FAAIY <br /> DIA PMNK Bi L 209 ) 368., 6175' •i . <br /> MAILINg AODREBB P.O. Box. 357 fpt 0 (_209 1 368 : 18'51 <br /> CItY Lodi ,^ stele CA 21v 952410357 <br /> IIII IMO AttNOUIEDDENENIT 1, the uderslgned coeur, operator or Agent of same, acknowledge that all elle end/or proleat specific <br /> PIIS/EIID hourly charges sesoalated with this facility or Activity mitt be billed to the party Identilleyl of the BILLING PANTY on <br /> Page 1 of this form. <br /> 1 also certify that I have prepared this applleatlon end that the work to be performed milt be dam in occordmmt with sit IAN <br /> juAcUIR c"ll ordlnence Codee , Bte ederst laws. <br /> APPLICANT'S 91CRATURE I _ <br /> title: Contractor valet 9/,7.5/9'8 <br /> l4; <br /> AUIIIORIIAIION to AELEASE INFOAMAtIONt, In addltlon to the above, when applicable, ,1,. the owner, operator or agent of ou",:�of•�:. <br /> the property toceted at the above site Address hereby suthorlte the release of any end all results, geotechnlcal'dete end/art-",," <br /> thvirormentel/elle assessment Information to IAN JOAOUIN COUNTY PUBLIC NEALIA BEAVICEB ENVIRONMENTAL NIALIN DIVII1011 N Soon Is <br /> It is evellabts s-A at the eama time It is provided to me or cry representative. ' ' • ,•i'I�'` <br /> 1 ��� � . � .. � .•, :� '��� <br /> NatmreefNrvlceAaqueeh 5 /=�/'✓0�, ,Zi'L �t_�:�L---' IarvlggCede <br /> AtilOTmd to Etployea B DAN <br /> MINOR <br /> Dole Rervlce Bmv(tted �/ / Further Action RequlredT Y / N =PROMAMlEM PIT ,•.,/ <br /> I <br /> lot Ama,ni . Amount Paid bete of Payment Psyment type Necelpl 1 Cheek I 'j NeEvd •ly.., <br /> ✓f� <br /> r 7G - <br /> .ane n I )/ (/ SUV _/_ ACCT / / Wit CLA <br />