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x SAN ' ?UIN COUNTY PUBLIC HEALTH SERV► ' <br /> NViRONMENTAL HEALTH DIVISION <br /> _ (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF TIIE PROPERTY AND/OR FACILITY <br /> LOCATED A 1645 Cherokee Rd. , Stockton , CA 95205 <br /> (Street Address) (City) <br /> i1FRFBY AU1IIORi7_E GeoAnalytical <br /> (l Abarnfnry) <br /> 'i0 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IiF.AIA If SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS iT 1S AVAILABLE AND AT THE SAME <br /> i iMF ur is PROVIDED TO ME OR MY REPRESENTATIVE. <br /> 11USiNESS NAME: ipT-- <br /> (if Applicnble) <br /> OWNER/OPERATOR: �- <br /> (mense /'tint) (7 1114) <br /> (U�rner/Uperabr Signantre (Dart) <br /> ADDRESS: d ( _ / S'�L.vGt-e-•� Si / Z <br /> (Alaillna Address) <br /> 57 2,-c4-c�✓ <br /> (City) ( <br /> ,� (Slate) (Lip Code) <br /> PiiONE: { �Oc7? oto 6; <br /> 1:11 23 046 (Revised 9/11/96) Page 9 <br />