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.5OP��U.!NPUBL HEALTH SERICES <br /> SAN JOAQUIN COUNTY Q + <br /> U): < <br /> JOGI KHANNA 1i.D.NI.P H <br /> Health Officer cP <br /> ( <br /> P.O. Box 2009 • 1601 East Hazelton Avenue) • Stockton, California 95201 4 F O Ra <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL 1 ICAL RES V LTS <br /> • GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATEDAT `300 I;A6T V-ETTUCMAN LAMS Lop <br /> (Street Address) (Cit') <br /> HEREBY AUTHORIZE A F P!,I IF D G EO 5y5Te W5 <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> `BUSINESS NAME: ATL ANTIC- E(LHP l C=LAD COMPAQ`( <br /> (If Applicable) <br /> OWNER/OPERATOR: PA W l(,TOr-J PRoJE-r MANA 2 <br /> (p e (Title) <br /> ignature) <br /> BA,RG HAU�N COtJSU(�T f►JG �tJ611J�Et�S <br /> ADDRESS: �,IZ 2J S�V t l.l.e I��D SUIT✓ I O 3 <br /> (Mailing Address) <br /> N0(LTH H(CHL-ANDS, CAA Q5/oloC� <br /> (City) (State) (zip code) <br /> PHONE: ( a ((o ) 34'b - 30'5-7 <br /> DATE: I I --I-Cl 1 <br /> EH 23 041 (REV 11/7/90) WP Page 9 <br /> A Division of San Joaquin County Health Care Services �� <br />