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HUG 11 ' 9Z 14: 02 FROPI LEPRINO TRPCY PROD. . PR6E . 001 <br /> 08/11/82 10;51 '$016 1013 SACRAMEN'l'0 00:/002 <br /> PUBLIC HEALTH SERVICES Q <br /> SAN JOAQUIN COUNTY <br /> JOG[KHANNA M.D.M.P.H. 1 <br /> Hnitll DffiKtl <br /> P.O.Bos 2009 • (1601 East linci on Amuc) • Stuckwn,Culi(utnia 95201 e <br /> (209)469-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AU1"HORZZA�" ION 'i"O RELEASE <br /> r ANALYTICAL RESULTS <br /> 4 GEOTECHNICAL DATA <br /> +t ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT .Zf 6i &,11ArJv4a ! l e- //cky <br /> (STg6ET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE KCC/qvf8c#'c z vc• <br /> (LRAORRTORY op- COAISULTANT) <br /> -TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAOUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 446?iciw �oOS_ _ --- <br /> err <br /> _(IF APPLICAELE) <br /> OWNER/OPERATOR: eA JOY CrRctad.vq,anii /�CrIryT ff--c (e <br /> (PLEASE PRJNTJ (T1 TLE) <br /> t� <br /> _ (SIGNATURE) <br /> ADDRESSs ,Z f/e/ �7/4s/7R77�u+t L0.wcr <br /> (MAILING ADDRESS) <br /> (CITY) (STATE) (IIP) <br /> PHONE: _(zo9 ) 835-- RSY0 <br /> DATES <br /> EH Z3 041 ReV19BC 10/89 <br /> A Division of San laaauln Caunn Heilt6 Gn G..7nr fkOlk : <br /> FUG 11 ' 9Z 9: 47 91E 366 7013 PAGE , 002 <br /> ww TOTnL Pn GE . G01 ww <br />