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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 /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT /J_ _ _�YJ /d <br /> ,1+S,t`re�Addre�s''sll JJ � (Lily) <br /> HEREBY AUTHORIZE_.1.2.UJ7 �Vi N/ <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: ('t4'u 6p <br /> ( Applicable) <br /> OWNER/OPERATOR: <br /> (Please Print) <br /> (rifle) <br /> (Owner/Operator Signature) <br /> (Date) <br /> ADDRESS: Y-A z �,/' Ald <br /> (Matting Add ss) <br /> iftlX537(0 <br /> i(Ciry) y (State) (Zjp Code) <br /> PHONE: (L-,�- y146 <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />