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' STE MITIGATION ACKNOWLEDGMENT/REQUEST FOR *CES FORM <br /> SAN JOAk IN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONM*CES <br /> HEALTH DIVISION <br /> SITE INFORMATION THER LEAD AGENCY <br /> ' ITE NAME AGENCY CONTACT <br /> Nestle Warehouse <br /> PHONE <br /> DRESS 4343 East Fremont Street ARM # 143-280-39 <br /> ' ITY Stockton, California IP 95208 <br /> ' BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Giles Engineering Associates, Inc. <br /> ' AILING ADDRESS 4875 East La Palma Avenue, Suite 607 <br /> Anaheim STATE CA IP 92807 <br /> ' <br /> 'I TY <br /> ONTACT NAME Gregory K. Mitchell HONE (714) 779-0052 <br /> ' vROPERTY OWNER/OPERATOR <br /> HONE 818 549-6157 <br /> AME Nestle USA, Inc. <br /> ' <br /> *DRESS 800 North Brand Boulevard <br /> TY Glendale TATE IP 91203 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> ' AME Smart S Final HONE 1 (213) 584-7301 <br /> DDRESS 4700 South Boyle Avenue <br /> ITY Los Angeles TATE IP 90058 <br /> ' AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> I, 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 JOAOUIN 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, I, 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 /> t ;AME Gregory K. Mitchell S# <br /> ATE 11-2-94 <br /> UY Giles Engineering Associates, Inc. ITLE Branch Manager <br /> 89 007(IV)12/90BILFRMI2 <br /> EH 29 01 <br />