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II/lb/2002 17:01 916-368-4202 <br /> 11/15/2002 14:52 "9467111B PARKMEST <br /> AGE STOCKT, PAGE 05 <br /> i PAGE 04 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> +ANALYTICAL RESULTS <br /> GEOTECHDRCAL DATA <br /> • ENVIRONMENTALISITE ASSESSMBNT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AMOR FAcam <br /> LOCATED AT <br /> P0007) 74U c>LT(Sneet Address) <br /> at- <br /> HEREBY AUTHORIZE �nI (City) <br /> `� '�lll �tut2a+i.. a .re La <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE GAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: <br /> }�(1jAppitcableJ <br /> OWNER/OPERATOR: 1 nniktN 1 �(�/�Q✓� _ <br /> (PletwePrtatj � (I"ule) <br /> t /-is-oa <br /> (Owner/Operator Si torture) (Dat*) <br /> ADDRESS: a2 (sp(e y� I�O0.tI <br /> (Mailiap Rdeben) <br /> 1 (City') (State) (Zip Cade) <br /> PHONE: i( Og )�i{ L O (o <br /> SR 23 046 (Reeved 3/15/02) pip 9 <br />