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a SI ITIGATION ACKNOWLEDGMENT/REQUEST FOR SERVICES FORM <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION <br /> THER LEAD AGENCY <br /> 'ITE NAME / Warmington Homes at Glencreek — Tract 2406 AGENCY CONTACT <br /> PHONE <br /> A1,14: V&-X,Au) E <br /> DDRESS Southwest Corner Tracy Blvd. and Valpico APN # . 69,- <br /> Tracy <br /> 9,-Tracy IP 95378 <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> aME Warmington Homes <br /> AILING ADDRESS 3160 Crow Canyon Place, Suite 200 <br /> ITY V San Ramon rATr / CA ;� �� 94583 <br /> 'ONTACT NAME ✓ Steve Millar HONE 510-866-6700 <br /> PROPERTY OWNER/OPERATOR <br /> AME Warmington Homes HONE 510-866-6700 <br /> DDRESS ✓ 3160 Crow Canyon Place, Suite 200 <br /> ITY San Ramon TATE I CA IP 1 94583 <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME HONE <br /> OGRESS <br /> ITY ISTATE IP <br /> ;-9-5° <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT s <br /> 1, 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, I, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE AND/OR PROJECT SPECIFIC <br /> PNS/END HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> APPLICANT'S NAME, TITLE, SIGNATURE/DATE <br /> AME1.//David4. Ryan s# <br /> IGNATURE ATE ✓ 9/22/92 - <br /> OMPANY Warmington Homes TITLE (/ President <br /> 89-007(lv)12/90BILFRMI2 <br />