Laserfiche WebLink
I <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AU'11-101UZAT10N TO RELEASE <br /> I <br /> I • ANALYTICAL RESULTS <br /> • OEOTECHNICAL DATA <br /> I • ENVIRONMENTAUSIIE ASSESSMENT INFORMATION <br /> I, T11E UNDERSIONED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCA3ED AT 2825 W Washington Street, Stockton, CA <br /> I (Street Address)) (City)HEREBY AU11IORIZI✓ <br /> (Laboratory or Consultant) <br /> 30 RELEASE ANY AND ALL ANALY'T'ICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> TIE <br /> AL`I 11 SERVICES AS SOON AS I r IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> I10 ME OR MY REPRESENTATIVE <br /> BUSINESS NAME' ZIVe"-s r ci e <br /> (if Applicable) <br /> OWNER/OPERATOR- <br /> (Please Pant) (Title) <br /> Af,6z <br /> I (Signature) <br /> ADDRESS' P , z Sg <br /> (Alarling Address) <br /> CY0 6- ,,,5 < 'A �Z3- g <br /> {Crry) (State) (zip rode) <br /> IPITONS ��5 'Z`f S— S`3 Z <br /> I <br /> DAI E, _ PAGE 9 <br /> I <br />