Laserfiche WebLink
12/03/2003 13:10 2094671"8 <br />\, <br />AGE STOCKTON <br />SAN 70AQUIN COUNTY PUBLIC HEAL -M 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 />r <br />PAGE 09/09 <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE P <br />R <br />OPERTY AND/OR FACT `Y <br />LOCATED AT "Ir (�t <br />(f') <br />HEREBY AUTHORIZE (zt V v,fn A7r/1Pti <br />TO RELEASE A.SE ANY AND ALL. ANALYTICAL INF'ORMAT'ION TO SAN IOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAIIABLE AND AT THE SAME <br />TIlAE IT IS PROVIDED TO ME OR MY REPRESENTATIVE_ <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />ADDRESS: <br />Prier) <br />Mx1e) <br />/Dare) <br />PHONE: ( 2M J - % A <br />EH 23 046 (Revised 9111/96) Dag <br />