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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AU'T'HORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECIINICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, 'THE UNDERSIGNED <br /> 7OWNER A/N'D/OR OPERAT9R OF TILE PROPERT(Y/AND/OR FACILITY <br /> LOCATED AT yl2—J / 2'7 AlJ J ►��Jc�n�✓ �F� <br /> ,wren dd ess) <br /> HEREBY AUTHORIZE i J o� -%c,c <br /> aborvloy or Consul(ant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIEALTII SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO <br /> ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME : J /7 ��/`t n f O N -IJ <br /> IJA pucable) <br /> OWNER/OPERA•TOR : J SA r <br /> 424,��Il <br /> de) <br /> ADDRESS: <br /> ()))ailing Address) <br /> C4--,r• ,��� .J „a 9, --2-DF <br /> (city) (stare) Mp) <br /> PHONE: Apy) y/ G - % V 77 <br /> DATE: <br /> Page B <br /> 191 23 041 (ReAsed 7-10-02) <br />