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SA N PJ O A Q U I N Environmental Health Department <br /> - COUNTY--- <br /> E(:;�EIVED <br /> AUTHORIZATION TO RELEASE MAR 9 12018 <br /> 'ANALYTICAL RESULTS ENVIRONMENTAL <br /> HEALTH F)EPARTMENT <br /> 'GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> "Ni-4t IV S T J C 7dJ� <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE v h 114 <br /> (Laboratory) 0 ' I <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRON[vfENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTATIVE. <br /> - BUSINESS NAME: <br /> fAppltcable) �I <br /> OWNER: <br /> (Please P Int) (Title) <br /> (Owner (Date) <br /> ADDRESS: <br /> S' ( ailing Address) <br /> _ (City) (State) (Zip Code) <br /> 6of6 <br />