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' PUBLIlC� <br /> HEALTH <br /> JOA [1IN NTY <br /> SAN Cott <br /> _ 4 �:,.�.. .a <br /> JOG[KHANNA M.D.,M.P.N. : + <br /> Neafrb Officer <br /> P.O. Box 2009 s (1601 East Hazelton Avenue) • <br /> Stockton, Caillforrila 9520! <br /> (209)468.3400 F a <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3427 <br /> AUTHORIZATION TD 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 21167 N. Tretheway Road$ Acam . CA <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE Weston Analytics 212 Frank West Circle Sto kt <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL-INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (IjApplicable) <br /> OWNER/OPERATOR: IV rr 4- <br /> l9 leajsJ� (Title) <br /> 4/'d* � s AlT��IJr "c9C1T �•C' <br /> (Signature) <br /> ADDRESS: ZZ, 6 <br /> r /- <br /> (Mailing Address) <br /> for"S7 C z--O/d Z 7 <br /> (City) (State) (zip code) <br /> PHONE: ( LAY�I� ! �� <br /> �ATE-- �Z <br /> 23 041 (REV 2/8/91) wP Page 9 <br /> �1lrfrlon of San Joaquin Cnunry Health Care 5ervltcs J <br />