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SAN JOAQUIN COUNTY PUBLIC HEP.L.TH SERVICES 4 / <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO REL 1;1 r: <br /> .0plIVED <br /> ' ANALYTICAL RESULTS FEB 2 8 1997 <br /> ' GEOTECHNICAL DATA ENVIRONMENTAL <br /> HEALTH <br /> ERMIT / SERVICES <br /> P <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �14 n \ ,-) L. STS c 1—Tc`ti\ <br /> (Street Address) (CuY) <br /> HEREBYAUTHORIZE _-_ <br /> (Laboratory br Consultant) <br /> TO RE. EsSE ANY AND ALL ANALYTICAL INFORMATION TO SAI1 JOAQUIN COUNT' PUBLIC <br /> HEAL i H SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSL`IESS NAME: <br /> (If Applicable) <br /> 'OPERATOR: <br /> - (Pleas t) (Tit/e� <br /> (Owner <br /> t r Sig re) <br /> wn <br /> ADDRESS:3�c 1 TtIT"�r�f c/' CItZ <br /> (Afailing Address) <br /> (Cirv) (State) (Zip Code) <br /> PHONE;( C`t ) L{ 7 S-2-711 <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />