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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209)468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT J 420 <br />j+OGk 4014 <br />(Street Address) (City) <br />HEREBY AUTHORIZE F L £./V V f hdJle N. o A �X <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />SAWAe,T, LNC._ Aa- �Ao Roobr- <br />(If Applicable) <br />OWNER/OPERATOR: C I t r oyot 'B yr mOckt;S s 4"A4 &!2 l rj Q=-V— <br />(Please Print) (Title) <br />Signature) <br />oR <br />(Date) <br />ADDRESS: 3 4 e 8 E. C &v peAACr 900.0 <br />(Mailing Address) <br />S4oc1CkoN 1S -$)DU <br />(City) (State) (Zip Code) <br />PHONE: ( 02 O G <br />s�a(oICo <br />EH 23 046 (Revised 9/11/96) Page 9 <br />