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IrI 1 k" 91 PK11ri 2,Crl1r 19UUttil 1.) 1,H, L111.l. <br /> 000 001 T tUSTEM JOAQUIN LOCAL HEALTH OIVICT <br /> AI 6mw,Pra 3 RtQ <br /> Icon Pfm tft;vlee Pre, 1601 E"K&MR0n Avenve San Jo"Ifin GCImty <br /> Tammy Jam,socy. Stvuc m,calltia 95206 fry a m4mtom <br /> Jamas F.Gulb�lltam omC4Y of EsWon <br /> Jghn D.mnxs kka JO(li f(tbX f* M.D.. MAX., 018TRICT MULTM Wtag C�oI� <br /> VhgWo M9ttle�ra Crly ul Tikoy <br /> rn SGhubo,,,DNA, E:NV I WNMENTAL HEALTH DIVISION Coy of MR" <br /> Daphne Show ( '9) 468-3420 Uft joatmn c <br /> HWM waawft Pha ounty <br /> CRY oI OW-kW <br /> ^WrH0Ft x Z+fig-r .TcjEN TcD mEL..l:A 1 sa^4004WnCWny <br /> ANALYTICAL RESULTS <br /> GECTECMN I CAL DATA <br /> -W ENVIRONMENTAL/SITE ASSESSMENT I NE'ORMAT I ON <br /> 1, THE UNDERSIGNED OWNER AND/RR OPERATOR OF THE PROPERTY AND/ER PAC I L I TY <br /> LOCATED AT 53 C5 L in/ <br /> (SlActl AE?SatE;SS) lir) <br /> HEREBY AUTHORIZE L If , <br /> tlAlft�GlT�E'T or rAJ��t r��r� <br /> Tb RELEASE ANY AND ALL ANALYTICAL RESULT'S, SE OTECHNICAL DATA AND/ESR <br /> ENVIRONMENTAL/SITE ASSESSMENT I'WORMATION TO THE SM JOAt,UIN LOCAL HEALTH <br /> DISTRICT AS SOON AS IT IS AVAILABLE AND AT THE SAME= TIME IT IS PMVIAED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (IF 1OPLIVOli tt) <br /> OWNER/OPERATOR; r <br /> (hEsSE fill r1 <br /> tSli� �If) <br /> ADDRESS i <br /> (WAItli¢ AMR(ss) <br /> - kelev <br /> (arr) 7 ($TALE) flip) <br /> taATE: 2 <br /> ;1 <br /> /' % / <br /> EH 23 'tib RQvi sed 1/83 . <br /> AdmWds"uun <br /> 468-3100 . Put,tIC g" <br /> 460-3420 466-M <br /> Aar>:olluuOr► �" � — <br /> "I-um 4694M <br /> �kJDS k1�0I1+1�tFdt! . <br /> 71ITPL P. 1 <br />