Laserfiche WebLink
0 <br />0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />. SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASER E 0 f- F11 V E D <br />* ANALYTICAL RESULTS AUG 2 1 Z017 <br />GEOTECHNICAL DATA ENVI RON ?�A E"itillA' L HEALTH <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION DEPARTMENT <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 3330 North Ad Art Road Stockton, CA 95215 <br />(Street Address) (City) <br />HEREBY <br />AUTHORIZE California Laboratory Services <br />(Laboratory) <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 SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: California Highway Patrol <br />(If Applicable) <br />OWNER/OPERATOR: California Highway Patrol AIP#-MA <br />(Please Print) (Title) <br />I'Z,,)l 7 <br />Signature) <br />ADDRESS: P. O. Box 942898 <br />(Mailing Address) <br />PHONE: ( 916 <br />EH 23 046 (Revised 7/26/2016) <br />Sacramento <br />(City) <br />F-rMT-11161 <br />(Date) <br />CA 94298 <br />(State) (Zip Code) <br />