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' 08-08-90 03: 18PM FROM TELIONG P08 <br /> PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> JOGI KHANNA M.D„M.P.H. <br /> Halth Officer <br /> dN <br /> P.O. Box 2009 • (1601 Gast Hazelton Avenue) . Srockrun,California 95201 <br /> (209) d68-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AWTMO R I ZAT I OPO TQ F2EL..EE,ASJE <br /> ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> + ENVIRONMENTAL/SITE ASSESSMENT INFORMATION _- <br /> It THE UNDERSIGNED OWNER AND/OR OPERATOR OF TH PROPERTY AND/OR FACILITY <br /> 44.4G/� �:y�O/Jtl JQTy Gp c BZW <br /> LOCATED AT ''� A-77 •4 6rQS`br✓ �T� 6" <br /> wmi <br /> EEf ADLTR&5_ ea—%g (CITY) <br /> HEREBY AUTHORIZE d 46:j=gr,.Q <br /> (LABORATORY or CONSULTANTJ <br /> ­TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR' <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME: <br /> (IF APPLICABLEJ <br /> OWNER/OPERATOR: <br /> (PLEASE PRINT) (TITLE) <br /> (SIGNATURE) <br /> ADDRESSt <br /> (NAILING ADDRESS) <br /> (CITY) (STATE) (ZIP) <br /> PHONES (__) <br /> DA7Ei <br />