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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 T <br /> LOCATED AT y7IJ /Y A/rpe I Wet'Y J / �C_& "N a0`5 <br /> (Street Address) I (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: PB u—e <br /> (If Applicable) / <br /> OWNERIOPERATOR: ! l�/7Q �6l (-e r// .G !4 )qae <br /> (Please Print) Male) <br /> ( roti (Owner/ erator Signature) (Dare) <br /> ADDRESS: <br /> (Mailing Address) <br /> 54 <br /> (City) (State) (Zip Code) <br /> PHONE: (pZU 9 ) 1y-� — 71 3 y <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />