Laserfiche WebLink
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 /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> 1933 Hiawatha Avenue, Stockton Ca <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE PTF-nicinn Fnvi= J-�'h steektan <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: Silveria Property <br /> (If Applicable) <br /> OWNER/OPERATOR: Mrs. Ethel Silveria - Propoerty owner <br /> (Please Print) (!Title) <br /> - - <br /> (Owner/Operator Signature) <br /> ADDRESS: 1933 Hiawatha Avenue Stockton Ca <br /> (Mailing Address) <br /> Stockton ca 95205 <br /> (Ci0') (State) (Zip Code) <br /> PHONE: ( 209 ) 467-8320 <br /> EH 23 046 (Revised 08113/99) Page 9 <br />