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PUBI,ic HEALTH SEWICES <br />SAN JOAQUIN COUNTY <br />JOGI KHANNA hl I). M H. <br />Heilth Officer <br />P.O. Box 2009 • (1601 East puaWn Avcwx) 9 Stockton CaUortua 95201 <br />(209) 46W3" <br />ENVIRONMENTAL. HEALTH DIVISION <br />(209) 4610420 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />I OWMCHNICAL DATA <br />I ENVIRONMENTAIAITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />I <br />LOCATED AT <br />It1 ; . JIMv ;� <br />TO RELEASE ANY AND ALL ANAL <br />TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE, <br />BUSINESS NAME: <br />OWNEWOPERATOR:, <br />ADDRESS: <br />code) <br />DATE: <br />PHONE. ( :2 C"7 1 9- `fC r/ <br />EH 23 041 (REV IV7/90).wp Page 9 <br />A PM" of sm )wWjin LAMW """ Gxe UMLa �� <br />