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PUBLIC HEALTH SER710ES ,o.�� h . <br /> o� <br /> SAN JOAQUIN COUNTY rt, <br /> "--j1. < <br /> JOGI f:H,�\NA Jf.U.�MTH <br /> . 1 <br /> Health Offiter L� <br /> . <br /> P.O. Box 2009 • (1601 Past Hazelton Avenue) • Stockton, California 95201 <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209) 463-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTALJSIT'E ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED <br /> AT <br /> TRSIGNED OWNER AND/OR OPERATORS OF PROPERTY AND/OR ��TnITY <br /> 10,500 4 , 4 � (� c <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE L\V :Pox'ti, <br /> (Laboratory or Consultant) <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 REPRESENTATTIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: iZey VL4c we-w JP-- LjuPfevwf <br /> (Pleaset (Title) <br /> z w'� A/- <br /> (Signatur <br /> ADDRESS: P 'ex I'7l <br /> (Mailing Address) <br /> Cj�c�c.t--rt>O Zn g51A1 <br /> (City) (State) (zip code) <br /> PHONE: ( Zc)'-) I �)$'Z - A 7`26 <br /> DATE: ,07-7 19f <br /> EH 23 041 (REV 11/7/90) wP Page 9 <br /> A DMsiun of.' n Imquin Cnunm Hmi 1 Cvc 4nices 10 <br />