Laserfiche WebLink
11/16/96 17:2' 140. 1©8 11105 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANDJOR FACILITY <br /> LOCATED A7 r I I•t�)5 a i irroc O <br /> (Street Address) (C'tY) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAU ABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: a u r V, C <br /> (Jf Applicable) <br /> OWNER/OPERATOR: RC" L <br /> (P[ease Print) aide) <br /> /Operator Signature) e) <br /> ADDRESS: <br /> (Mailing Address) <br /> o 3 <br /> (City) (State) (rP Cade) <br /> PHONE: ( Q 6 -Z - 8 <br /> EH 23 046 (Revised 9111196) Page 9 <br />