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dao .*1U - dun 6:5Y,'M Y, " ONI :NG•&-NV •CTCG INC. No •4590 " 2/2 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3410 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> ' GEOTBCHNICAL DATA <br /> y ENVIRONMENTAL/SPIE ASSESSMENT INFORMATION <br /> 1, THE LNDERSIGNF35�OyW Y <br /> OWNER AND/OR OPERATOR OF TnE PROPERTY AND/OR FACILIT <br /> LOCATED AT 14 / 7® ,-r2lQa 4-X0/1 <br /> (Sneer Address) (City) <br /> HERESY AUTHORIZE c 4 S <br /> ¢a8orwo y) <br /> TO RELEASE ANY AND ALL kKALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME TS PROVIDED TO MF OR MY REPRESENTATIVE, <br /> SUSMSS NAME: foA f sit f z If <br /> (IfAFPricable) <br /> OWNER/OPERATOR: !'r f S_ q y/nom <br /> (Pleas PriAr) (n1le) I74 A 4,f V't <br /> i- 2� 03 <br /> (O perator Signaare) (Dare) <br /> ADDRESS: �KI Z.Aelr l eleAe�-,i <br /> rmaihng Addreis) <br /> (ClrY) (State) rAp Code) <br /> PHONE: <br /> a IZ f ) f12 <br /> EH 23 045 (Revised 08/13199) Page 9 <br />