Laserfiche WebLink
;i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> f <br /> • <br /> ANALYTICAL RESULTS <br /> j <br /> ` GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SrM ASSESSMENT INFORMATION <br /> ;L <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2512 E. Waterloo, Stockton, Ca 95205 <br />€ (Street Address) I (City) <br /> HEREBY AUTHORIZE Mc Campbell Analr i-cal and UpgrZpnit F.nd'irnnmmra]('QnSUIjgars, Tnc_ <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> Waterloo Liquor A <br /> BUSINESS NAME: O° q <br /> (If Applicable) <br /> OWNERIOPERATOR: Mr• Heng Chea tank_operator <br /> (Please Print) (Title) <br /> G -c <br /> (67� e /Operato acture) <br /> 2512 E. Waterloo- <br /> (Mailing <br /> aterloo <br /> ADDRESS: _ <br /> (Mailing Address) <br /> Stockton California 95205 <br /> (City') (State)' (Zip Code) <br /> PHONE: ( 209 463 4114 II! <br /> �!E <br /> j <br /> DATE: 19 September, 1997 j <br /> EH 23 041 (Revised 7-10-92). Page 9 <br />