Laserfiche WebLink
A. <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> L <br /> I. the undersigned owner and/or operator of the property and/or facility <br /> ,located at <br /> -Whereby authorize (1AT.TFY)RN7A Tap7�R IARC $ <br /> to release any and all analytical results, geotechnical data and site <br /> t assessment information to the San Joaquin Local Health District as soon s <br /> .' , <br /> aS it is available and at the same time it is provided to me or my <br /> 'e4-representative. <br /> Owned/Operator: - Titled <br /> Address Ali <br /> Phone: >� <br /> 04 fs_37(� <br /> te::;� Z L /R i • <br /> ft. T <br /> l <br /> 00466 <br /> ORIGINAL <br /> EH 08 05 UGT 1s3 <br /> AttP}itanirt Of jTrV;1V11 l—The above prices,specifications <br /> ;. <br /> and conditions are satisfactory and are hereby accepted. You are authorized Signeto do the work as specified. Payment will be made As outlined above. <br /> Date of Acceptance`- SiflnaturrykfJ <br /> FORM x 183 Available bom NCIS Inb..Gel MYL OIUI <br /> �Uu1lnnnu uy s Date -TALI Aa l J1tg 07 Accepted by* Data <br /> 0 R 1 t r,s, 9 <br />