CORRESPONDENCE_DTSC LETTER - Laserfiche WebLink

Home Browse Search

rirr t 44�r W"Ift r+! MrW lO"M two I he" t10 tin"Ulm kvwft rh NLf At !1 N1 tha grrpgrt GatlEarl+on7_rd Ur�f +v+ri -�� ea lrr+.�ert3oK, rKr.�erY rt,e caxiid �gri+prnwrr� !O rr,e e�1en1 AVlhoriO�of P"[xtit�l C)T 8� P'rr7to the Zed by lava gryd►�eC eSsa ArOvided iS th19 aCCP95 omp" 0"Cr rnbrmF1t,rm may the narne s a ro eleph i n a lawful pur rtY and Of e p Po9P Of acknowled nY other ( 1 and telephone nrImber of the 9es that DTSC may b isms who reside at the Pro In this access agreement and that trehquired to obtain Percy. The property owner(s) permittin Permits for certain activities authorized Property owner's name and contact info g authority may require DTSC to provide the rmation. ADVANCE NOTIFICATION DTSC agrees to the Property. provide advance notice to the undersigned before beginning activities on p dY� DTSC will work with the pro dates and times for all activities. Upon party owner to coordinate mutually agreeable property owner copies of analytical results andt�reDports obtained from sam agrees to make pling to the Property p g taken on the LEGAL AUTHORITY TO GRANT THE ACCESS I certify that 1 am the legal owner or authorized agent of the owner of the Pro e above, and that I have authority to grant such access. This written permission is given with knowledge of indicated Voluntarily, on behalf of myself and all other co-owners of this property, my right to refuse and without threats or promises of any kind. g ow This access is effective on the date of m F execution of this a reement set forth below. This rant of Pro art access shall terminate u on DTSC's com letion of the activities described in this a reement. All activities will be erformed between the hours of 7:30 am to 6:00 rn. Signature (Please sig in Ink} Print Name b PA Date DTSC internal use: l Envirostor Site Name APN Property Owner Consent for Access to Property (10/2022)