Laserfiche WebLink
S A A'} I O A Q U( �I Envir I I rt <br /> —.—COUNTY 111 <br /> AUG 2 7 2018 <br /> AUTHORIZATION TO RELEASE EfyNlRnNMENTAL HEALTH <br /> *ANALYTICAL RESULTS DEPARTMENT <br /> *GEOTECHNICAL DATA <br /> *ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> �Z �aV v,-LZ b Z6-7 <br /> (Sit-eel Address) (00) <br /> f /�I <br /> HEREBY AUTHORIZE <br /> (Laboratoi)) .1 -;ek! - O tib* <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br /> SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 7- (e�rRh �v� Zob3 <br /> (YApplicable) <br /> OWNER/OPERATOR: Jose Rios Mgr, Environmental Services <br /> (Please Print) (Title) <br /> 08/06/2018 <br /> ner/Operator Signature) (Date) <br /> ��2sJ-o-.n �t�� 0 -- t) <br /> ��� Z 1 1 R�4`t 5 � Ix <br /> 75 z21 <br /> ADDRESS: 'I- , %- 1 <br /> (kailing Address) <br /> d <br /> (City) (State) (Zip Code) <br /> PHONE:( 972-82�-6592 <br /> 8 Of 10 <br /> I <br /> i <br />