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PUBLIC; HEALTH SERIKES ,o <br /> ^Q. �o <br /> •G <br /> SAN JOAQUIN COUNTY y< <br /> JOGI KHANNA INLD.,M.P.H. <br /> Health Officer ., <br /> u <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) • Stockton,California 95201 't�iFda��tr <br /> (209) 468-3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> ,- 1 (209) 468-3427 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> r <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2101 E. Charter Way Stockton, Ca. <br /> (Street Address) (City) <br /> L., HEREBY AUTHORIZE GenAnal art i c,al f 2horatori es <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 /> 1*0 ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 1,Ow .11 gat.hp. Mo e Home Sales — <br /> `� (If Applicable) <br /> OWNER/OPERATOR: Lowell Rathe Owner - <br /> (Please Print) (Title) <br /> (Signature) <br /> ADDRESS: 2101 E Charter Wav <br /> (Mailing Address) <br /> Stockton, Ca. 95205 <br /> (City) (State) (zip code) <br /> PHONE: (_209 ) 948-1077 <br /> DATE: <br /> 3/2/92 <br /> EH 23 041 (REV 2/8/91) wp Page 9 <br /> A Division of San Joaquin County flcalth Carcservices <br /> V <br />