Laserfiche WebLink
v I.I <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY 1 <br /> LOCATED AT Z�jcx� F 6 1 L-,1AT th � `�TtaG�' ToA <br /> (Sweet Address) (City) <br /> HEREBY AUTHORIZE (Street �L-A.— D�pl-1T \C-A�— <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (nIfApplicable) .1 <br /> OWNER/OPERATOR: KiV02EW /7 LOTL �`/AN Et- £/►'✓iRaWme�+�i9� /�6,nr. <br /> ( ease Print) (Title) <br /> (Owner/Operdtor Sig Lure) ( are) <br /> I <br /> i ADDRESS: PO BeC S09S �cx5/Y) �E� P <br /> (Mailing Address) <br /> I <br /> n �r(City) (State) (Zip Cade) <br /> PHONE: ( 7I� ) 8Z3' 884pee <br /> I <br /> I <br /> I <br /> EH 23 046 (Revised 08/13/99) Page 9 <br /> I <br />