Laserfiche WebLink
Jul 22 09 10:19a J.R. Beard <br />805-540-5241 p.6 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSME ORNfATION <br />1, TIIE UNDERSIGNED OWNER AND/OR OPERATOR OF TEE PROPERTY AND/OR FACILITY <br />LOCATED A 1801 WEST 11th STREET <br />ATT WEST 11th STREET, ,' TRACY CA <br />(Street Address) <br />HEREBY AUTHORIZE MCCAMPBELL A*A,LYTICAL, INC. <br />TO RELEASE ANY AND ALL ANALYTICAL INFO TION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AT THE SAME <br />TDwfE IT IS PROVIDED TO ME OR MY REP NTATIVE. <br />BUSINESS NTAIVIE, <br />OWNER; <br />STAN OLEA c/o SAFESJAY,/INC. <br />(If Applicable) <br />FUEL CENTER OPERATIONS MNAGER <br />( lee Pr nt) (Iltle) <br />.�.—KC4- Z `� <br />(Owner Srgnalure) (Date) <br />ADDRESS; 5918 STONERIDGE rLU L ROAD <br />(MadingAddress) <br />PLEASANTON CA 94588 <br />(City) (State) (Zip Code) <br />PHONE: ( 925-� 467-2707 <br />EH 23 046 (Revised 02/20/09) <br />5 <br />