Laserfiche WebLink
* j0QUIN COUNTY PUBLIC HEALT ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> *ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> �v, -- b 1 )1 <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Corral Hollow Road Tracy California <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE California Laboratory Services <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: Lawrence Livermore National Laboratory <br /> (If Applicable) <br /> OWNER/OPERATOR: C.Susi ackson for .v` ;v <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) <br /> ADDRESS: 7000 East Ave. P.O.Box 808 <br /> (Mailing Address) <br /> Livenrore CA 94550 <br /> (City) (State) (Zip Code) <br /> PHONE: (510)423-577 <br /> DATE: L,6 /q 3 <br /> EH 23 041 (Revised 7/10/92) <br /> 9 <br /> r <br />