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FEB-02=04 17:29 FROM-KLEEI(AN ROEBSELEN 916-939-1169 T-746 P.13/17 F-539 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (309)469-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL"SULTS <br /> *GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITZ ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER ANDIOR OPERATOR OF THE PROPERTY ANDS�///OR FFA��CILITYY� <br /> LOCATED AT /.,d.L, lI .QLdil r+y �. " , .5'� r r�IBJrs.Lt.CS •-2'�r' . <br /> (5rreef Address) ' 9') <br /> HEREBY AUTHORIZE <br /> (LaLvrafary) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT 19 AVAILABLE AND AT THE SAME <br /> TIME 1T IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (rl PPl(cableJ <br /> OWNER/OPERATOR: G vI1160N <br /> � (Pl a Prim) YIeJ <br /> f er/Ope for Sig Tfyel (D e) <br /> ADDRESS7 9 Vv!S I�U,41� <br /> (Maung Address) <br /> (City) (Srare) Rip Code) <br /> PHONE: (31c�6_) W 1 - 0* <br /> i <br /> EH 23 046 (Reoised 06/13)99) Page 9 <br /> I <br /> i <br /> RECEIVED FEB-11-04 15:09 FROW9169581011 TO-KLEEDIAN ROEBBELEN PAGE 11 <br />