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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 /> ' ENVIRONMENTAIJSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROP�E�RLT.,Y,AND/OR FACILITY <br /> LOCATED AT �✓ '7 I/'%� + L FJ3 L /l Tat l c 1 (� � <br /> (Street Address) 7 <br /> HEREBY AUTHORIZE Pig tr%i Azl-.t; JC I? l JC <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: krC .. A�( � n rte, <br /> (If Applicable) <br /> OWNER/OPERATOR: r,4t Ly <br /> e ) (Title) <br /> (Own r/Operator Signature) (bale) T <br /> ADDRESS: CP1�(�P�L 'h+"�f rL)-1 <br /> (Mailing Address) p /� <br /> 1—Cti l�lx�i4- l(t l 14 ` Vot")27 I'n j- <br /> 5 (City) q (�, (State) (Lip Code) <br /> PHONE: ( t 61 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />