Laserfiche WebLink
- 0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />Si <br />5D O Sm. PC szc-5 <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: e lktvo2'i- 6w& /&& <br />(If Applicable) <br />OWNER/OPERATOR: <br />ADDRESS: !s—.600 SSS , y": rt�el?-r <br />(Mailing Address) <br />S� cri - u <�k , q<�-Zoc <br />(City) (State) (Zip Code) <br />PHONE:( f-0 Q ) !293 — ©Zs2 <br />EH 23 046 (Revised 1/24/02) <br />A <br />