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(3 <br /> PUBL HEALTH SE ICES <br /> SAN JOAQU[N COUNTY <br /> JOG[KHANNA QLD.,M.P.H._ i <br /> . Health 0#ficei• .� `P:. <br /> P.O; Box 2009 • (1601:East Hazelton Avenue) 0.Stockton,CalifotYt�a 95201 <br /> i6 6* <br /> ,� :t <br /> (209) 468-3400' <br /> 4 j <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209):468-3427 <br /> AUTIFIORIZAUON T4 . RELEASE <br /> * ANALYTICAL RESULTS <br /> F' <br /> " GEOTECHNICA.L DATA <br /> *. ENVIRONMEN'TAUSITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY. ANDIOR FACILITY <br /> LOCATED AT 1 W. Turner. Ed. .Lodi. <br /> Street Address) (City) <br /> HEREBY AUTHORIZE T�rra Environ. mental Services <br /> (Laboratdry or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS.AVAILABLE:6 D AT THE SAME TIME ITIS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. V <br /> BUSINESS NAME: Ford Construction Company Inc./ Jim Thorpe Oil, Inc. <br /> (If APPlicable) <br /> OV�1;IER/OPERATOR: Same as above Owners <br /> se Print 4 (Title). <br /> (Signature) <br /> ADDRESS: <br /> .I'..0.' Box .357.. <br /> (Mailing Address) <br /> t <br /> Lodi -. Ca. 95241-0357 <br /> (City) -(State) (zip code) <br /> PHONE: ( 209 ). , 368-6175 <br /> DATE: 5/7/92 r . <br /> EH 23 041 (REV 2/8/91) wp "Page 9 <br /> A Division.of Sart Joaquin County.fiealth fare services <br />