Laserfiche WebLink
ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> r <br /> ANALYTICAL RESULTS <br /> :GEOTECHNICAL DATA <br /> " ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> 18806 LOWER SACRAMENTO ROAD WOODBRIDGE <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> i <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 TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESSNAME WCODBRIDGEAMPM <br /> (If Applicable) <br /> OWNER:3ASS ENTERPRISES <br /> (Please Print) (Title) <br /> (Owner Signature) (Dare) <br /> ADDRESS: <br /> (Mailing Address) <br /> 18886 LOWER SACRAMENTO ROAD WOODBRIDGE CA 95258 <br /> (City) (Stare) (Lip Code) <br /> PHONE:(209 )339.8238 <br /> EH 23 046 (Revised 07/17/14) <br /> b <br />