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EN% <br />MONMENTAL WEALTH DE <br />SAN JOAQUIN' COUNTY DEPARTMENT <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />" ANALYTICAL RESULTS <br />' GEOTECHMCAL DATA <br />ENVIRONMENTAL/SITE ASSF.SSxENr INFORMATION <br />I, TEM UNDF.RSiGNED O R AND/UR OPERATOR p� T� PROPERTY gNij/pR FACILIT' <br />LOCATED AT / - <br />(St eet.Qdriress) <br />HEREBY AUTHORIZE (City) <br />( 46on7lory1^% <br />TO <br />RELEASE ANY A�rM� M, ANALYTICAL INFpR►vIAxMON TO SAN JOAQUII�i COTJNTYp <br />DEPARTMENT AS SOON A IT TS AVAILA$LE AND AT Tl� SAME <br />T'ME IT IS PROVIDED TO OR My REPRESENTATIVE. <br />JiUSINESS NAME: <br />OWNER- <br />- <br />— :IRA <br />ADDRESS: `L--GL7� <br />---t— <br />PHONE: <br />EII 23 046 '(Revised 02/20/09) <br />Mae) <br />R <br />.. 9 sem"]-/� <br />RONMENTAL HZAL 1 H <br />I <br />ZO/Z3 39Vd QDOd SV9 3ND d 9L9LEE8G0Z 05:E0 OTOZ/6Z/60 <br />ZO/Z3 39Vd QDOd SV9 3ND d 9L9LEE8G0Z 05:E0 OTOZ/6Z/60 <br />