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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY t �� <br /> JOG[KHANNA M D,M P H <br /> Health Officer <br /> PO Box 2009 • (1601 East Hazelton Avenue) •Stockton,Caffornta 9520E <br /> (209)468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3427 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 6540 E. Janaunt Rd. Acarnpo, Calif. 95220 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE Weston Analytical <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN 3OAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS 1T IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME, <br /> (If Applicable) <br /> OWNER/OPERATOR <br /> (Please Pnnt) (Title) <br /> ;�9� 'r, �=�-;� — <br /> A6afore) <br /> ADDRESS' 654a E. Jahaunt_ Ret__ <br /> (Marling Address) <br /> Acampo,- Calif. 95220 <br /> (City) (State) (zT code) <br /> PHONE. 299 )_ 36.q.-9Q94-- <br /> EH 23 041 (MV 2/8/91) wp Page 9 <br /> A Dlrtelan or Un toa"Ln County Health Cre Services <br />