Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209)468-3420 <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 1,5--o <br />So / #� S 7— � A <br />V– � r y <br />(Street Address) (City) .,% <br />HEREBY AUTHORIZE <br />dva.nC-eCA: Ie® tY\0" <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME(ORrMY REPRESENTATIVE. ,^ / <br />0.L A C <br />BUSINESS NAME: TE <br />(If Applicable) <br />OWNER/OPERATOR: <br />Q. r N652LAy JA2 Y– <br />�—(Please (Title) <br />� o <br />(Ownif/Operator Signature) (Date) (Date) <br />ADDRESS: 5S-0 % % S C <br />(Mailing Address) <br />PHONE:() 0 3 J-- " / 8 ) C) <br />EH 23 046 (Revised 1/24/02) <br />(State) (Zip Code) <br />6 <br />