Laserfiche WebLink
v v <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (709) 468-3470 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 740 N. filbert St. , Stockton, CA <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE GeoAnalvtical Laboratories <br /> (Laboratory or Conuokma) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION 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: 1 `AfY1S U fp o I E S I IAI-e <br /> (If Applicable) <br /> OWNERIOPERATOR: V F- wy\ YY1S Lt' <br /> (Please ' [) (Title) <br /> �671 <br /> J , <br /> er/Operator ignature) <br /> ADDRESS: P 0. 73.)" <br /> (Mailing Address) <br /> cz4oc-Hot') ) � <br /> (City) (State) (Zip Code) <br /> PHONE: ( ,2U j ) / (o L - E7-33 <br /> DATE <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />