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JOITIGATION ACKNOWLEDGMENT/REQUEST FOR SERV{ IFORM <br /> SAN JOAQUIN COUNTY • PUBLIC HEALTH SERVICES/ENVIRONMENTAI.ilEALTH DIVISION <br /> SITE INFORMATION <br /> NER LEAD AGENCY <br /> ITE NAME AGENCY CONTACT <br /> Franklin High School <br /> PHONE <br /> DRESS APN <br /> 300 North Gertrude Ave <br /> aS Z O <br /> ITY Stockton IP � /�3;(PIa C ,gQv/ !± ' <br /> BILLING / RESPONSIBLE PARTY INFORMATION V�� <br /> Stockton Unified School District <br /> !LING ADDRESS 1932 N. E1 Pinal Dr. <br /> ITY Stockton TATE CA �'P 95205 <br /> TACT NAME Charles Leubner. HONE (209) 944-4078 <br /> PROPERTY OWNER/OPERATOR <br /> Stockton Unified Sch o ONE _ <br /> rDRESS 1932 N. El Pi nal Dr. <br /> Stockton TATE IP <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br />{ HONE <br /> f � <br /> i <br /> DRESS <br /> ITY TATE IP <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 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 /> APPLICANTS NAME, TITLE, SIGNATURE/DATE <br /> E Charles Leubner S# 052-44-0795 <br /> 1GNATURE [ATE 1 6-19-91 <br /> [OMPANY Stockton Unified School District ITLE Asbestos/Hazardous Material <br /> Ipchnicipn <br /> 89-007(1V)12/908ILFRMI2 €, <br /> e- <br />