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i u i +c�c�lb rtsG F .l�ri <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> MWIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> * ENVIRONMENTALSITE ASSESSMENT INFORMATION <br /> THE UND:to[GNED!OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILI'T'Y <br /> OCATED AT l(uv <br /> (Scree!Address) ( rY) -- <br /> EREBY AUTHORIZE <br /> D RELEASE AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COLTITY PUBLIC <br /> EALTH SER CES-E:NVIROPW0NT'AL HEALTH DIVISION AS SOON AS IT IS AVAIIABLE AND AT THE SAME <br /> Mb IT IS PR VIDE6 TO ME OR IMY REpRF-sENTATIVE. <br /> BUSII` SS NAME:' <br /> 001APP&-able) <br /> )WNER/.OP TOT-: 3/LL /YIE,ZG Z�%1,4<<✓C <br /> lease ) �) <br /> 7 <br /> (Owner/Operator Sipu=re) B) <br /> DRES�: <br /> (��g address) <br /> �L� ����C �A �✓�- '7 <br /> ( ') (St,=e) (Z1p Code) <br /> (PHONE: <br /> 046 (Revis�d 10/19/98) Page 9 <br />