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61 it 0- '%A11011 ACKHM EDGMENF/REGUESF FOR SERVICES F^STE <br /> SAN JOAOUIN c i PUBLIC HEALTH SERVICES/ENVIRONMENTAL HE! DIVIISICW <br /> SITE INFORHArfON <br /> gE <br /> ITE NAME f <br /> Panella Family Trust <br /> J <br /> DDRESS <br /> 2150 E. Fremont St. F <br /> IP <br /> :1 T Y205 <br /> n ;r <br /> 95 <br /> Stockto , Ca. <br /> T)TLLfHO / RESPON919(E PARTY IHFORHAFIOPI <br /> - 1 <br /> 1 Trust <br /> )AHE Robert and Dorothy'i;Panella Owers of Robert. and Dorothy Panella Fame y <br /> IAILING ADDRESS 5000 E. Fremont St:'. <br /> :try Stockton, { FATE <br /> :outAcr HARE Art Pratt IIaIE (�209)94J�5000 <br /> ;;. <br /> PROPERTY OWNER/OPERATOR ) <br /> 'HONE (209)943-5000 <br /> .AME Paraella Family Trust '� <br /> DDRESS 5000 E. Fremont .St. <br /> :ITT Stockton TATE Ca IP 95215 <br /> CLIENT INFORMATION (IF DIFFERENT FRU; CWHER/CPERATOR) <br /> IIOHE <br /> )AHE <br /> DDRESS <br /> TA1E IP <br /> :TTY <br /> wINORIlAT10N TO R(LEASE/BILLIHG ACKNUUT.rOfEHENI <br /> I, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGEIIT Of SAME, OF THE PROPERTY LOCATED AT THE ABOVE fSI1E ADDRESS HEREBY <br /> AUTHORIZE THE RELEASE OF ANY Alto ALL ANALYTICAL RESULTS, GEOtECHNI.CAL DATA AND/DR ENVIRONHENTAL/SIZE ASSESSMENT 1NFORNAt1OH 10 <br /> SAN JOADVIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONHEHIAL HEALTH DIVISION AS.SOOH AS IT IS AVAILAOLE AND AT IIIE SANE 1I14E It Is; <br /> PROvIDED t0 HE OR MY REPRESENTATIVE. <br /> IEHI, C# AGENf,6F SAME, ACKNOWLEDGE THAT ALLSITE AND/OR PROJECT SPECIFIC <br /> ADDlT#ONAILT, F, TILE UNDERSIGNED OWNER, OPERATOR, CL <br /> PHS/EHO HOURLY CHARGES ASSOCIATED WITH THIS ACIIVITY DILL er 9ILLED±10 THE PARTY IDrNTIFIED'ABOVE AS THE "RESPONSIBLE PARTY". <br /> .PPtICANT'S NAME, TITLE, SIGNATURE/DATE f <br /> SR <br /> ;AME <br /> P Ar;E <br /> SIGNATURE ;ISI <br /> TITLE. Owner. <br /> :DMPANr Panella �'amil Trust �C ` � <br /> a•O0T0 V)t2/90BfLFRH12 r <br /> i <br /> 4 <br />