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PUBLIC HEALTH SERVICES �~ <br /> SAN JOAQUIN COUNTY <br /> Q: Z <br /> ~' JOGI KHANNA M.D.,M.P.H. 1. <br /> Health Officer <br /> c P <br /> P.O. Box 2009 . (1601 Gast Hazelton Avenue) . Stockton, Califurnia 95201 9��FOP�` <br /> (209)468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION J " 1989 <br /> (209) 468-34E0 E1 <br /> 9=�w-117 MH I ZAT I OfV TO f:REl._EAE3E <br /> ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1403 Country Club Boulevard Stockton <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE IT Environmental Services/IT Analytical Services <br /> _ (LABORATORY or- CONSUL TONT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT 1'S AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: BP Oil Company <br /> (IF APPL I CABLE) <br /> OWNER/OPERATOR: BP Oil Company (W.J. Hollis) Environmental Engineer <br /> (PLEASE PRINT) r (TITLE) <br /> ( GNATURE) — <br /> ADDRESS: 2868 Prospect Park Drive Suite 360 <br /> (MAILING ADDRESS) <br /> Sacramento _ _CA 95670-6020 <br /> (CI TY) (STATE) (ZIP) <br /> PHONE: —(-916 ) 631-0733 <br /> DATE: /C�) d <br /> EH 23 041 Revised 10/89 <br /> A Division of San Joaquin County Heahh Care Services ' <br />