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JIM. THORPE. OIL. INC 209 368 1851 P. em <br /> 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 /> • ENVTRONMENTAL/SITE ASSESSMENT INFORMATION <br /> LIE UNDERSIC +ED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> ; ,,_ATEDA'T MSPS/ f?Z�taiJ7�Wtlu2 /���✓? <br /> (Street Address) ff (City) <br /> •i.tEBY AUTHOk ZE _�--FD /f7✓�� yT7 L <br /> (Laboratory) <br /> ELEASE AN' AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> :::.LTH SERVIC ,S-E;\VIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> .IE iT IS PROV )ED 1`0 ME OR MY REPRESENTATIVE, <br /> BUSINESS X 1ME: <br /> gApplicable) <br /> ,NNEsR/OPERF 'OR: /7Z,;7— - <br /> (Please Print) (Title) <br /> -l/0 -9� <br /> (Owner/Operator Signature) (Dare) <br /> ADI ZJW; s�i,s'i �' �1o.✓a c.,>P-�� _ <br /> (Mailing Address) <br /> 11�, 9533- <br /> (City) (State) Zip Code; <br /> Ft ON1. ( 2Orl <br /> uo tRmst. 10/Iat98) ?age 9 <br />