Laserfiche WebLink
Post-it®Fax Note 76710 Date �/ZL qc f `pag s� <br /> �- <br /> C Co. <br /> Phone# Phone# <br /> 1 �� -3 <br /> Fax# � ) <br /> 2l J SS9 - c5 2,156 Fax# <br /> SITE MITIGATION PROGRAM <br /> BILLING LETTER OF ACKNOWLEDGEMENT: <br /> TO: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (PHS—EHD) <br /> 445 N. SAN JOAQUIN ST. <br /> P. 0. BOX 2009 <br /> STOCKTON, CA 95201 <br /> FROM: <br /> (property owner name) <br /> (owner mailing address) <br /> (city, state, ZIP) <br /> RE: <br /> (site address) <br /> I (We) declare that the assessment activity being performed at the <br /> above referenced site is being conducted with my(our) knowledge and <br /> approval. Furthermore, I (we) acknowledge that payment of PHS-EHD <br /> charges will become my(our) responsibility in the event said <br /> charges are not paid by the client and/or operator identified on <br /> the attached "General Program File. " <br /> (signature and title) (phone number) <br /> (date) <br /> LC\BILACKN.FRM <br />