Laserfiche WebLink
SANU I Environmental Health Department <br /> C0UNTY __ <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ENVIRONMENTAL / SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNEXOR ND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> (Street Address (City) <br /> HEREBY AUTHORIZE <br /> (Laboratojy) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFO TION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILAB AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRES TATIVE , <br /> BUSINESS N E : <br /> (If Applicable) <br /> OWNER: <br /> (Please Print) (Title) <br /> (Owner Signature) (Date) <br /> ADDRESS : <br /> (Mailing Address) <br /> (City) (State) ip Code) <br /> PHONE : <br /> 6of6 <br />