Laserfiche WebLink
SA.+JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468•]420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECIINICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1. THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 100 E. Lodi <br /> " Ave. , Lodi, CA 95240 <br /> isJ// <br /> (City) <br /> IIERFBY AUIlIORiZE GeoAnalYtcalLaboratories <br /> (laho�nlary) <br /> l0 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIEALIII SERVICES-ENVIRONMEN"FAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIMF I'1' IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: _ G' i L 4 <br /> (1j Applicable) v <br /> OWNER/OPERATOR: <br /> (Ppiprim)_ aille) <br /> s " s� . <br /> IOnner/Operator Signature) (Date) <br /> ADDRESS: 100 E. Lodi Ave. <br /> (Alailing Address) <br /> Lodi, CA 95240 <br /> (City) (Stale) (Lip Code) <br /> PIIONE: ( ?09 ) 334-6144 <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />