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PUBLIC HEALTH SERVICES 1Q9P� <br /> SAN JOAQUIN COUNTY y Y� <br /> JOG[KHANNA M D.M P Il <br /> Ifeakh Ofhcrf �* <br /> F0 Sox 2049 • (1601 last Iiuchon Avcauc) •Stocktun.CaU(urnla 95201 <br /> (209) 466 3404 <br /> ENVIRONMENTAL HEALTII DIVISION <br /> (209) 468-3427 <br /> AUT 110RIZATION TO RELEASE <br /> + ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> LIP ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> 1, T}IE 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 /> Weston Analytics 212 Frank West Circle <br /> HEREBY AUIf10RiZE 5 0 <br /> • (I dboratoiy or ronsullunt) <br /> TO RELEASE ANY AND Al L ANALY TICAL[NFORMA'l ION'l U SAN JOAO(IIN Cot JN I Y P001 W <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND ATI IiE SAME TIME IT IS PROVIDED <br /> TQ ME OR MY REPRESENTATIVE <br /> BUSINESS NAME: <br /> (1jAppltcable) <br /> OWNER/OPERAIOR f 4 I <br /> } (Title) <br /> 19 1 p 4e 401 "1110 <br /> (Sr �ateere) <br /> ADDRESS. 2-2, <br /> (Afatlrng Address) <br /> Sn C-&-r`v J C� ,1-2-/ <br /> (City) (State) (zip code) <br /> PHONE <br /> Ell 23 041 (REV 2/8/91) wp Page 9 <br /> A Division of San J0304 County"ca"C"c Sctvices �� <br />