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-EOUG 13 '92 _10.:.02 nMMCO2G_g465013*�w SACRAMENTO p,2 121UU2/UU2 <br /> IF <br /> SERVICES <br /> PUBLIC HEALTH >4 s. <br /> SANJOAQUIN COUNTY �. <br /> .i JOGI KHANNA M.D.,M.P.H. 1 _ <br /> Hnhh Otficec <br /> p,0.Sox 2009 • (1601 Easc Hazelwn AYcnuc) . S[uCkoJn,Cali(ucnia 95201 <br /> (20D)468.3400 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-34?0 <br /> Au-rHORZ 2A7' ION TG RELEASE <br /> ANALYTICAL RESULTS <br /> +� G90TECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 11 THE UNDERSIGNED OWNER AND/OR OPERATOR OF THC PROPERTY AND/OR FACILIYY <br /> LOCATED AT W55r L-A"f SYOck7wz^/ <br /> (STREET ADDRESS) (CITY) <br /> HEREBY AUTHORIZE ICE/ti GeQf <br /> (L)PBORATORY or CONSUL 1-ANT) <br /> -TO RELEASE ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR <br /> ENUIRONMENTAL/SITE ASSESSMENT INFORMATION TO SAN JOAOUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE ANA AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: law_Y1191L1111-a( Aoep <br /> AF'ALICADLE) a <br /> OWNER/OPERATUR7 S(ooP . 1 �+FsidtvT <br /> (FLCASE PRINT) (TITLSJ <br /> (SIG ATUREJ <br /> ADDR9551 ,Zed! BESn <br /> T � .vP <br /> lMA1LSNG ADDRESS) <br /> ca. 9sx o e <br /> 5^ccA Td ✓ (STATE) (ZIL') <br /> (CITY) <br /> PHONE: <br /> DATE: <br /> EH 23 041 Revised 10/89 nDl.i,iaAof San jaw.;.ce.nryH,.I,hC."Acf.-, PAP <br />