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Walton Engineering 9163731172 <br />pro s*q // a, #q <br />,peloo � # A& <br />SERvIcf REOVEV <br />iACILITY ID B 1 00 ) O^ 9 n i RECORD ID <br />INVOICE e <br />P. 03 <br />(EN 00 61) Rivised ef2v93 <br />031�12� <br />;AGILITY NAME I�GCL I� 15 1-9t 1--120 BMING PARrym � Y / (� <br />si'E ADDRESS �,� / %�%r �/� P2/17�Or+ 0a a --._-;V�Z_ <br />o <br />CITY S o_ le_- 4o/-1 �. CA ZIP q�:x. c 9 AUG 2 6 1996 <br />cA.a�aK/vvExgro+l fYl / �Gc /*� 2 i%C_l-CJ- _ -_- M�IIallL1k11GneA�hTs ,, / N <br />D$A QU//� /4 /J_ 122 /CST .Zf%C PMCr.'c� 'NCS <br />a;aDREss -t�' <br />0, 6 o X 5- -7 <br />/5—�_ �.- PHONE tt2--- <br />CITY F rZ G Yvl O V1 1 STATIE C A <br />APN at .F— Land Use Application It <br />281,0-180— 0 ,5-- <br />zip 75/5- 3 i <br />07 sag Dist Lacanian code 1{ <br />:�Nr�ACTo� and/or —�� <br />ZvlCi:�RliOUESTOR 1 C� La..�Q-.r 6I.Ltxr, PAIR <br />DQ;A_W 1 V%,Y\ 1 BCW t Z ll C ._ ... — PHONE 01- EZ <br />NAI..INC, AAOResS 7 3 v� /5/Cry �l1/7 TAX -1 1.f ) 3-23 <br />CITY 50r- a C%7L,--F) -. STATE C,'V _ LIP —�5 /rL <br />81LLI1J; ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge, that Ai: lite a,x!!o,- project SpeCific <br />PHS/;SAD hourly charges associated with this facility or activity wilt be billed to the party identified as Thea1LLIRG PARTY on <br />FOSe 1 oe this form. ( 0Wn;IZ/61PCy-G(+C,0- C-i:51C 11 rpt parte . <br />I rt.a•) certify that 1 have red is apptication and that the work to be jw-rfpriw-d m;tl be done in accordance with all SAN <br />JOA0 110 CiVMTY ordiM70 C S and t arda, state and FederaL laws. <br />APD::CANTIS SIGNATUR�-� l.C. C a� <br />LI 1 <br />Date: AUG 2 6 1996 <br />AVTACRILATION TO RELEASE INFORMATION- In addition to the above, when applicable, I. the owner, operator or ageni of saw of <br />the property located at the above site address herebyauthorize the release of an and all results, AN `) )A UIN' COUN I <br />y geotechnica or <br />P' r tlG HEALT { SERVICES <br />environmental/site assessment information to SAN J©ACUIN COUNTY FWLIC NEALYN SE,tvICE$ ENYIRONNENIAL HEALTM�,pp ��S pp ae55 �ppoorn as <br />t.N1�iFi IV iF11 AL �titAl._T-H �_?4VISInr <br />m`, tg aveilatAe and at the same time It i9 provided to me or ay representative. <br />Netvre Of Service ' 1QRe—gUe3t: �i�lled�� L.�II�.LtAA J� setvtcC Code O/ 3 �___ <br />A'-&1%ncd to �pi1 + Eaployee N Date / <br />gat* Service Completed / / Further Action Required: Y / N PROGRAM ELEMENT—L... <br />Flat Amount <br />Amount Paid Date of payment <br />Payment Type <br />Receipt N <br />check R <br />Reevd By <br />/)006.0000 <br />be ori -7- <br />®,3 7- <br />