CORRESPONDENCE_DTSC LETTER - Laserfiche WebLink

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Depariment of Toxic Substances Control T mecoam•• . 10D1 `T'Sb'"l a.n.t.rr kx P O BM W6 Saam+enlo•Cpl&rnia 95812-0N6 PROPERTY OWNER CONSENT FOR ACCESS TO PROPERTY Property 600 N.Main Street,Manteca,Ca 95336 Zip CODE Address: CITY STATE STREET ADDRESS o property Owner or 669-777-861 �20<1 p Y Indra and Savitri Yadav F Property Manager: h Contact Pho a No. Name completing this form: 0t j e Address (If different): Contact Phone No.: �k v Email Address: Identity Confirmation (check one): c'Driver's License ❑California State Identification (ID) Card ❑Other(type): i by virtue of my ownership or as agent for the property owner identified above, and any structures located on the real property(collectively referred to as the"Property), hereby grant access to the Property to the Department of Toxic Substances Control (DTSC), its officers, employees, and authorized representatives, including consultants and contractors, for any or all of the following activities related to DTSC's investigation and potential cleanup of contamination at the Property: List of Anticipated Activities: 1. Investigation, including but not limited to passive or active soil gas sampling, indoor air sampling, outdoor air sampling, sewer/drain sampling, groundwater sampling, boring through soil, and/or soil sampling. 2. If warranted, Interim Mitigation Measures, including but not limited to implementing remedial measures to protect human health and the environment. 3. Implement remediation, if necessary, to protect human health and the environment. I understand that DTSC needs to obtain access from the legal Property Owner prior to taking any action on the Property. I further understand and acknowledge that my signature below authorizes access to the Property as described in this agreement, and 0 Printed on Recycled Paper