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SANJ O Q U I EavIronmental Health Department <br /> COUNTY <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> *❑R TLC{NICAL DATA <br /> *ENVIRONMENTAL/SM ASSESSMENTINFOMY3ATION <br /> 1,THE UNDERSIGNED OWNER ANDM OPERATOR OF THE PROPERTY ANDfOR FACILITY LOCATED AT <br /> 7000 N Mich$el Canlis Blvd,Fleneh Camp <br /> (Skeef r cNress) Ply) <br /> Bagley Entcrprivos-t~ontnLoWj'EREHY AUTHORJZE <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAlr9 TW IT IS PROVIDED TO NM OR <br /> MY REPRESS TATIVE. <br /> BUSINESS NAAffi: <br /> ({f Aloicabla) <br /> OWNER _,San Joaquin County <br /> {ease Print) - -T- (Trrie) <br /> I� el. /' 5-/- z- !��— <br /> (O%vner s;pw1r►j�c) (Dale) <br /> ADDRESS: P O Hex 1810 <br /> (A lariirrg rJrlckcs,$) <br /> — _ 5tocklorn CA 952.01 <br /> (city) Pa(c) cxP C94*) <br /> PHONE: <br /> C_2o9___�_951.75009 <br /> BONS <br />