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�%w <br />..01 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DMSION <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 4 i 9f v` W <br />(Street Address) (City) <br />HEREBY AUTHORIZE GeoAnalytical laboratorie <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: AIRPORT WAY LUBE CENTER <br />//�' /'^��\ (!f Applicable) <br />rMVD DCDN'1 TTr%V. l K to ( /,i,f /i <br />ADDRESS: <br />Address) <br />r <br />PHONE: zl�Z ©Z 5- 3 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />(title) <br />(Dare) <br />(Zip Code) <br />