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PUBLIC HEALTH �. <br /> SERVICES �a <br /> SAN JOAQUIN COUNTY <br /> r•` <br /> JOGI KHANNA M.D.,M.P.H. t> <br /> Healih Officer J. <br /> ppp�t <br /> P.O. Box 2009 . (1601 East Hazelton Avenue) . Stockton,Califut tt <br /> (209) 468.3400 YYY���IDIDID <br /> FES 10 1993 <br /> ENVIRONMENTAL HEALTH DIVISION ENVPEMIfi/ Va TH <br /> (209) 468-3420 <br /> AIJTHOF2I ZATION TO F2EILEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> It THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 15615 Seventh Street, Lathrop, CA <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE Dr. Kent S. Murray <br /> _ (LABORATORY or- CONSULTANT! <br /> TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR' <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: Langston's Market <br /> (IF APPLICABLE) <br /> OWNER/OPERATOR: James Langston <br /> (PLEASE PRINT) 1 (TITLE) <br /> i <br /> U (SrGNHTURE <br /> ADDRESS: / _ , 0 , 13" X17 <br /> (MAILING ADDRESS) <br /> Gc '�—A <br /> (CITY) (STATE) (ZIP) <br /> PHONE: <br /> DATE: a _ 613 n <br /> EH 23 041 Revised 10/89 <br /> \.-e)ivision of San jo.quin County Hr.rlrh('orr Srrvirre �"-'i" <br />