Laserfiche WebLink
MGT NCS STOCKTON CA 2"ad"k 440409 <br />0 w <br />T rT- <br />PUBLIC HEALI I H SERVICE� <br />S&N J0AQL,'1'i4 CO(AM <br />JOG 1(14 ANNA AD, M.P.H. <br />Htilth Offkcr <br />P.0, Box 2009 - (1601 East Hazelton Avenue) - S(ock-con, Califacnia 95201 <br />(209)468.3400 <br />ENVIRCNIMENTAL HEALTH ]DIVISION <br />(209) 468-3427 <br />AUTHOWZATION TO RELEASE <br />P.01 <br />• p W,ONA,j, <br />QVTAt <br />ANALYTICAL E <br />RESULTS Tkqcot ,, <br />" GEOTECHNICAL DATA. <br />• E,.NVIROjNLMEkNTA",Sr1rE A5SESSNiENT INFORMATION <br />1, THE UNDERSIGNED OW'i,42R AZ4D!OR O?ER.ATOR,OF THE PROPERTY AANDIOP. FACILITY <br />LOCA; "E`t,' AT, ROUGH �i R TOCKTON <br />(Sired( Address) (city) <br />WF - <br />.4 -REBY AU-MORIZE PJ�Q FNVIRONMENTAL,,,,..INCA <br />(Laboratory or Consultant) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAdN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICF-S AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />T 0 ME: OR MY REPRESENTATIVE. <br />BUSINESSNAME: IINTnATTON 9TATTQW qTQCXT.QN-,-, <br />(If Applicable) <br />OWNER/OPER-ATOR: E. G. MONINGER, Jr CON, NANnTNn nVVTrPR <br />(Please Print) (Title) <br />(Sighalure) <br />__V 0XMCTAL---r0DE <br />ADDRESS: N --- -- 33 <br />(Mailing Address) <br />STOCKIQNx CA 22203-5000 <br />(city) (State) (zip code) <br />PHONE: 944-0400 <br />,[DATE. <br />P0$t4t1' brand tax transmittal memo 7671 1 *1 Pages <br />,"B r— o <br />EH 23 041 (PIV 2/8/91) wp Fro�a (- V4 <br />Co <br />A joiquin CoYACY He Phone V <br />