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. . <br /> � <br /> , <br /> PUBLIC HEALTH SERVICES <br /> SA00A0U|NU}UNTY <br /> OGIKHANNA M.D.,M.P.H. <br /> Health Officer <br /> l!C). Box 2UO9 ° (1601 East Hazelton Avenue) ° Stockton, California 95201 <br /> (209) 468']400 <br /> ENVIRONMENTAL HEALTH DIVISION DEC & - - - <br /> (209) 468-3420 -. -�~ ^ �u� <br /> n ?0�"M�:NTdL A��L�/ <br /> �� / <br /> �� ���� � � �� ��� <br /> � � ��� � ��� ��� ����� _ � <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> ' <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (STREET ADDRESS) (CI TY) <br /> HEREBY AUTHORIZE <br /> (LABORATORY or CONSLILTANT) <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> `— <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: BP Pipelines <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: Northwestern Equipment & Supply CompaLiy David Garner Manager <br /> (PLEASE PRINT) (TI TLE) <br /> ADDRESS: 635 Gilman Street <br /> (MAIL INS ADDRESS) <br /> Berkeley CA 94710 <br /> PHONE: _(415 527-4080 <br /> EH 23 041 Revised 10/89 <br /> , xDivision v[San Joaquin[o. rynmltho"�e°;c" t*-% <br />