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Mar 11 02 10: O1a MP�SIE 6 CO. (9161923-4664 p. 3 <br /> 2i3f? NAM n.rN 96 EPP11 ES ,, � u.E .E3 P <br /> I <br /> SAN)OAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468.3620 <br /> AUTHORIZATION TO RELEASE <br /> •ANALYTICAL RESULTS <br /> •GEOTECHNICAL DATA <br /> • ENVMONMENTAIISM ASSESSMENT INFORMATION <br /> 1. ME UNDERSIGNED OWNER APD/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATEDA'P .3GZq S A ZftF r W4y, STr�f-KT, <br /> (Stre)et AMMW Ply) -HEREBY AUTHORIZE 1-o 614-A ty lf% <br /> (above") <br /> TO RELEASE ANY AND ALL,ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PCBLTC <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 /> (IfAppHcable) <br /> AA �� Lo <br /> OWNER/OPERA3T)R: Iv1 u- 71 li <br /> (�a Printf <br /> — (0iftar Operator Ag�Vrlf! (Dore <br /> i (MaiGsg Addrar) <br /> rcu) (scar) (nP co&) <br /> PHONE: I - c'1 L 3 '- `I 00 Q ._ <br /> I <br /> EH 23 066 (Reviled 08;IV%) Page 9 <br /> I <br /> l <br /> 1 <br />