Laserfiche WebLink
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 20 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> s GEOTECHNICAL DATA <br /> ENVIRONMENTAL4SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNEDOWNERAND/OR OPERATOR OF TliE PROPERTY AND/OR FACILITY <br /> LOCATED ATHEREBY N <br /> (Street Address) (City) <br /> A OR _ v < <br /> (Laboratory or Co ) <br /> TO RELEASE ANY AND ALL ANALYTICALINFORMATION TO SAN JOAUIN COUNTY PUBLIC <br /> HEALTH SERVICES SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> REPRESENTATIVE.TO ME OR MY <br /> BUSINESS ® / <br /> (If Applicable) <br /> OWNER/OPERATOR: / / <br /> (P a t) (Title) <br /> c <br /> (Ownerj0perator Signature) <br /> ADDRESS: 14> bf <br /> t <br /> ( aifin A ) <br /> CA <br /> (City) (state) (zip Code) <br /> PHONE: ( } <br /> DA <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />