Laserfiche WebLink
SAM JOAQUIN COUNTY PUBLIC HEALTH VICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONNIENTAL/SITE ASSESSIMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 2201 WEST WASHINGTON STRIET, STOCK -EON CA 95`2-03 <br />(Street Address PP <br />C451� & VI Fzt? - 1 <br />HEREBY AUTHORIZE <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN CC <br />(City) <br />NTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO NIE OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />STOCKMN PORT DISTRICT <br />(If Applicable) <br />BARRY R., NICHOLSON, RNIRONi1IF1VTAL SPECIALIST <br />ADDRESS: PO BOX 2089 <br />(Mailing Address) <br />STOCKTON, CA 95201 <br />(City) (State) (Lip Code) <br />PHONE: ( 209 ) 946--0246 <br />EH 23 046 (Revised 9111/96) Pave 9 <br />