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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 46&3420 <br /> AL HORIZATION TO RELEASE' <br /> ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2S /0 /1k.. C � /r_x.L; - 2-. . <br /> (Street Address) (City) <br /> I IEREBY AUTHORIZE M L - X10/ z -- <br /> (Labmwory or Consukant) <br /> TO RELEASE ANY AND ALL ANALY'T'ICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME:.ar <br /> (If Applicable) <br /> OWNE OPERATOR C-� r� e C! <br /> (PI e P 'nr) (Tule) <br /> T <br /> ,��,( OPerato Signature) <br /> ADDRESS: 6,.7/0 440 , <br /> (Afailing <br /> (City) (Stare) (zip Code) <br /> PHONE: --- <br /> DATE: <br /> Li 1 23 041 (Revised 7-10-92) Page 9 <br />