SITE INFORMATION AND CORRESPONDENCE

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Michael J. Infurna Jr. Senior REHS SanJoaquin County Site Mitigation Unit IV / LOP Public Health Services, Fifth Floor Environmental (209) 468-3454 304 E. Weber fax: (209) 468-3433 Stockton, CA., 95202 AND Fc4pix l05ff - yv From: MICHAEL INFURNA, REHS To: ELIZABETH LU, CHEVRON / GEOMATRIX. Fax #: 925-842-0213 Pages: 4 (includes cover sheet) Phone: 925-842-1343 Date: September 14, 1999 Re: BORING PERMIT APPLICATION, & BACK PAGE (LCD), + "GREEN" MFR FORM • Comments: HERE ARE THE FORMS WE ARE NOW USING FOR PERMITS AND STARTING UP NEW SITES. YOU MAY SAVE THEM AS MASTERS AND REPRODUCE THEM AS YOU NEED. IF THE CONSULTANT SIGNS THE APPLICATION, THE C-57 SHOULD FILL IN THE BOTTOM OF THE "LICENSED CONTRACTOR DECLARATION" (LCD). ONLY THE C-57 CAN SIGN THE LCD OR THE "AUTHORIZATION TO SIGN" AREA. THE CONSULTANT OR THE C- 57 CONTRACTOR CAN FAX THE SIGNED FORMS TO PHS-EHD. PROCESSING THE PERMIT CAN ONLY OCCUR AFTER THE FEE IS RECEIVED AT PHS-EHD. PERMIT FEE IS $89 PER PARCEL PER APPROVED WORK PLAN. A SEPARATE CHECK FOR $234 SHOULD ACCOMPANY THE "GREEN" FORM. STATEMENT OF CONFIDENTIALITY.-The information in this facsimile is legally privileged and confidential information intended only for the use of the addressee listed on this cover sheet. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient,you are hereby notified that any dissemination,distribution or copying of this telecopy is strictly prohibited. If you have received this facsimile in error,please notify us immediately by telephone at the number listed on this cover sheet and return the original message to us at the above address via United States Postal Service. We will reimburse your costs in notifying us and returning the message to us. Thank You.