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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />* ANALYTICAL RESULTS <br />al I lk1 % 1 1;;111111111111 0 - � - No <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 975 S. Fairmont Avenue Lodi <br />(SVWAd&=) (City) <br />H I ZBY AUTHORIZE U-1-4- <br />(Labonawy or tanndwq) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIO <br />MIMI* =I. IF I !111 11 0 . 0 i I v ..rllllll��illillillillillillilliI <br />=F. 1 1 11111 1 foe % 01151111AIN <br />OW'NERIOPERATOP, Richard Sandford ,-'Adm;bnistrator <br />(Please. <br />,Pdht) (7-uk) <br />ADDRESS: 975 S. Fairmont Avente, Lodi, CA 95240 <br />(Mailing Address) <br />- Lgdi CL 95240 <br />(Chy) (State) (Zip Code) <br />r.ZA MrA a = I I <br />DATE. /41-5-- 49 <br />v <br />