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;F <br /> .r t <br /> PUBLIC HEALTH SERVICES �..a...N.. <br /> SAN JOAQUIN COUNTY r." <br /> JOGI KHANNA M.D.,M.P.H. <br /> Health Officer <br /> P.O.Box 2009 . (1601 Easr Hazelton Avenue) . Stockton,California 95201 <br /> 'tK �lFppe��t <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (2U9) <br /> 468-3420 <br /> AUTHC) R I ZAT I mm T© REL.EAiaE <br /> ANALYTICAL RESULTS <br /> -* --GEOTECHNICAL.-..DATA %-'..,.....- ""�. <br /> ENVIRONMENTAL/SITE ASSESSMENT� INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOROF THE:- PROPERTY AND/OR FACILITY <br /> LOCATED AT 91 THOMSEN ROAD, LATHROP- CALIFORNIA <br /> - (STREET ADDRESS) _ (CITY) <br /> HEREBY AUTHORIZE _ WallaCa-Kuhl and -Associates ,' <br /> _ it fL.9BORATORY or CONSUL TANT) <br />' <br /> -TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA 'AND/OR: ' <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN 30AQUIN 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 /> i <br /> BUSINESS NAME: <br /> I (IF APPLICABLE) <br /> OWNER/OPERATOR:' - RAYMOND M. QUARESMA <br /> (PLEASE PRINT) (TI TLE) <br /> r <br /> (SIGNATURE) <br /> ADDRESS: <br /> (MAILING ADDRESS) <br /> Manteca). California 95336 <br /> (CI TY) (STATE) (ZIP) <br /> PHONE: 209 } 823='1455 <br /> DATE: <br /> EH 23 041 Revised 10/89 i <br /> A Division of Son Joaquin County Heahh Care Services <br />