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• • EUMUNu G. RHVWN Or, <br /> -a, y awGnxon <br /> MRf'A. RCCRIOVEE <br /> Water Boards *apE,.R.'on <br /> d1M6NTM GRCi6Ci1CN <br /> Central Vallev Remonai Water Quality Control Board <br /> ACKNOWLEDGMENT OF RECEIPT OF <br /> OVERSIGHT COST REIMBURSEMENT ACCOUNT LETTER <br /> I, , acting within the authority vested in me as <br /> an authorized representative of <br /> a corporation, acknowledge that I have received <br /> and read a copy of the attached REIMBURSEMENT PROCESS FOR REGULATORY <br /> OVERSIGHT and the cover letter dated 30 September 2015 concerning cost reimbursement for <br /> Central Valley Water Board staff costs involved with oversight of cleanup and abatement efforts <br /> at the Shell pipeline, 25705 Patterson Pass Road, Tracy, San Joaquin County. <br /> I understand the reimbursement process and billing procedures as explained in the letter. Our <br /> company is willing to participate in the cost recovery program and pay all subsequent billings in <br /> accordance with the terms in your letter and its attachments, and to the extent required by law. <br /> I also understand that signing this form does not constitute any admission of liability, but rather <br /> only an intent to pay for costs associated with oversight, as set forth above, and to the extent <br /> required by law. Billings for payment of oversight costs should be mailed to the following <br /> individual and address: <br /> BILLING CONTACT <br /> BILLING ADDRESS <br /> TELEPHONE NO. <br /> RESPONSIBLE PARTY'S SIGNATURE <br /> (Signature) <br /> (Title) <br /> DATE: <br /> KARL E. LCNGLEY SCO, P.E., CHAIR I PAMEIA C. CREEDON P.E., BCEE,[XCOIrtNE gnnlDEn <br /> 11020 Sun Center Drive#200,Rancho Cor0ova,CA 95670 1 www.waterboarde.ca.gov/centralvelley <br /> ICJ flECYCLGC pPPGR <br />