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80"0 Of rRULIE[S SAN JOAQUIN LOCAL HEALTH UISTR.CT aln"mc <br /> Al Ceror rrpa JOROV.n f <br /> Een�'+T4+ %W VW-0 PrOL 1601 East Harehon Avenue SM+.000 O! C.Own►7 <br /> . <br /> Tw" oym Se, r bio,i,ton Caillornla 95205 Cillil EantecR <br /> " ,r'el As F Cuam,�ro' q OI <br /> ;rry of.uo <br /> John Q 14aaL M D JOG ICHAMIvx t►1 0 W P H 019TRiCT 14L4LTM pifICEH City or iracr <br /> 1w ItAFlnerl <br /> - fic^ubart,D% $A ENLIRDNh1E-NTAL HEALTH DIVISIDtqcity V1 Ripon <br /> Daphne Stow �iCi6-3421+ San JoeOuin Covnq <br /> �y WrMwma P(.D Cao or Slocl+nm <br /> Son Josat m Counry <br /> AUTHC)R X ZL..EASE <br /> -ee- ANALYT I CAL RESULTG <br /> ie- GEOTECP4N I CAL DATA <br /> -4* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1 , THE UNDERSIGNED OWNER AND/OR OPERATOR OF THF PROPEPTY AND/OF' FACILITY <br /> LOCATED AT -,:i tt .1,-1 irz R0,1d, 'r icY+ Cf <br /> (SIATtl AiiiiiS) rCr1�i <br /> HEREBY AUTHORIZE I,( I nrpr fnvirnn+iPn1n1 rnoinppritln Rancho i ordnva , C,8 !4](1 6IR360r, <br /> 11480x,wif or CONSUTA11) <br /> TO RCLEASE ANN' AND ALL al,,,. LYTICAL FESULTS, GEOTECHNICAL DATA AND/Ok <br /> ENVIPONMENTAL/SITE ASSESSMENT INFORMATION TO THE SAN JOAQUIN LOCAL HEALTH <br /> • DISTRICT AC SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> rO PIE OR MY PE PRESENTATIVE. <br /> BUSINESS N'AmE i I f 1111;1* 1 <br /> riF ,�rr1lcAAlr) <br /> r) DU= +1DUi; l'nl ^,�1 ,, <br /> OWNER/OPERATRA: r _ �� i-+ r <br /> r WEASr TIN (IITIE) r <br /> rstrr�t�rxr) <br /> ADDRESS; <br /> r <br /> l rN f+5 i l <br /> rrrrr rs)��u rrtr) <br /> PHONE• ( ')9� +] <br /> DATE: ; - - -- <br /> 4 23 041 Revised 1 /Va <br /> Adrwruylra4vn CI nlca'Sorvicar (nvlryAmenu+H�oIIA Pubi-c H&44+hurting <br /> 486 3400 Aft 3d 30 466 3420 468 3880 <br /> Ak Pa+4u4oA Community S+rwcoA Labr-rat,ry WIG <br /> 488 3470 •6a 3470 466-34LC+ <br /> 4168 3360 <br /> .r <br />