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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 I �J a S Co r rc, 14 o(lou-) l\cl Trac(.1 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE GeoAnalytical Laboratories <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 /> (If Applicable) <br /> OWNER/OPERATOR: SW�1) <br /> (Ple Pri little) <br /> (Owner/Operator Signature)^ (Date) c7 <br /> ADDRESc7`D ,�DIDC� �,sif9[1/L� CO�[liQ s[JI��OCL�� <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( /r� —�c�� ' AG[/0 <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />