Laserfiche WebLink
+ ~ <br /> PUBLIetEALTH SERVviCES <br /> t SAN JOAQUIN COUNTY <br /> JOG[ KHANNA INID.,NI.P.H. <br /> Health Officer <br /> P.O. Boz 2009 • (1601 East Hazelton A�Tnue) ! Stockton. California 95201 C'Fo <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTII DIVISION <br /> (209) 468-3427 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> " ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATEDAT ' 16500 W. Clifton Court Road Stockton , CA <br /> (Street Address) r (City) <br /> HEREBY AUTHORIZE F .G .L. Environmental <br /> (Laboratory or Cortstillartt) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND ATI-HE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE.. <br /> BUSINESS NAME: Sarale Farms , Inc . <br /> (If Applicable) <br /> OWNER/OPERATOR: Thomas Sarale Secretary/Treasurer <br /> (Please , . (Title) <br /> z <br /> igttaturc) _ <br /> ADDRESS: P. 0 . Box 6066 <br /> (Afailitig Address) <br /> Stockton CA 95206 <br /> {City} ���---_-_--- (,State) (zip code) <br /> Pf-IONE: (_2 0 9 ) 943-2079 <br /> DATE: <br /> EH 23 041 (REV 2/8/91) wp page 9 <br /> A Division n[Sin jmgnin County ilnlai Carr Scnicrs \/� <br />