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EN IRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Tclephoue: (209) 468_3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />` GEOTECI-PqCAL DATA <br />" ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, TIM LJND*FRSIGNED O R AND/OR OPERATOR OF T"E PROPERTY AND/OR FACILI1 <br />LOCATED AT <br />(St eet Ad&ess) 1110 -T -A <br />(Cin') <br />HEREBY AUTHORIZE <br />( 4borntory) <br />TO RELEASE ANY ANTD L ANALYTICAL INFORMATION TO SAN JOAQUIN COrTNTY ET <br />DEPARTMENT AS SOON A IT IS AVAILAZLL AND AT TIE SAME <br />TIME IT IS PROVIDED TO OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />OWNER: <br />.SRA i i <br />ADDRESS: <br />PRONE.I 1 <br />Err 23 046 (Revised 02/20/09) <br />—W� 4 <br />('fide) <br />(Date) ^ ^ <br />(Stare) (Zip Code) <br />5 <br />;RONMCNT AL HZAL I H <br />z0/z0 39Cd 0003 SV9 3N0 v 9L9LE£860Z 05:C0 DZ13Z/6Z/60 <br />