Laserfiche WebLink
s <br /> ` SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEAL DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> Ah <br /> $ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILI <br /> LOCATED AT <br /> (Street Address) ) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SANIO COUNTY ENVIRONMENTAL HEALTH <br /> mw <br /> AMW <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TAME IT IS PROVIDED TOME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> W (IfAppl' e) <br /> ONER/OPERATOR: <br /> (Please Print) ('Title) <br /> (Owner/Operator ature) (Date) <br /> ADDRESS: <br /> (Ma' Address) <br /> (State) (Zip Code) <br /> PHONE:( } <br /> EH 23 046 (Revised 1/24/02) <br /> 6 <br />