Laserfiche WebLink
CA at�►. t14 E 'V.nn�ct SOC ► *, S*w Jo• uM� lOd1 <br /> i�1 <br /> AA"t,64111. v&n 5w*..y.A two East Halelton Avansia,P. O. Bo: 200, _ 1 9 C�oliwir, <br /> Slockton, Ca111Q(W&95201 Cllr a_ Crux s Eaeaeon <br /> E.r� t•1w1.nt.t Mawl.C.- <br /> F.f n BY0004 • . 2D9/466-6781 Cur of 1upoc ` <br /> IL Ftor.s - -Gtr or ruacmc� <br /> o. M.sr. M o r Cllr a T1,4 <br /> "Jt.,J. WAd. Jog$ Kh nna. MA.. Jt.. 04611 A H.aila officer S*4JoaatitnCo NMV <br /> Ids Ann& Lor. - _` � !vu►nGgygt�r <br /> •S <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS. GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> 1 . the undersigned owner and/or operator of the,, property and/or facility <br /> located at l.-L. V� <br /> hereby authorize �� �PT �- 1R Lg6S <br /> to release any and all analytical results. geotechnical data and site <br /> assessment information to the San Joaquin Local Health District as soon <br /> es it is available and at the same time it is provided to me or my <br /> representative. <br /> Owned/Operator- Title: OW�� <br /> Address S (op(rL Phone: <br /> —r —Z . S � <br /> _Li n <br /> It 08 (]S 0C.1 13 <br />