Laserfiche WebLink
SAN JOAQ UIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <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 <br />2375 Tracy Blvd. Tracy CA <br />(Street Address) <br />HEREBY AUTHORIZE <br />(City) <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 OR MY REPRESENTATIVE. <br />Eric Janzen <br />BUSINESS NAME: Gettler-Ryan Inc. <br />(If Applicable) <br />OWNER/OPERATOR: <br />t Zlb-j Agent for ConocoPhillips <br />(Plea Print) (Title) <br />n7�-" <br />perator Signature) (L <br />ADDRESS: 6Broadway Suite <br />(Mailing Address) <br />Sacramento CA 95818 <br />(City) (State) (Zip Code) <br />PHONE: (916) 558-7649 <br />EH 23 046 (Revised 1/24/02) <br />