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M <br />..101 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />• ANALYTICAL RESULTS 1p- <br />* GEOTECHNICAL DATA AUG 311999 <br />ENVIRONMENTAIJSITE ASSESSMENT INFORMA <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />I - 32.5 S. 6L bmfAbb S-K� <br />(Street Address) (City) <br />HEREBY AUTHORIZE TW kK l V4 G L4V$ S <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN 1OAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TOME OR MY REPRESENTATIVE. <br />BUSINESS NAME: �l & S r = � "tl''�� � " ' _ &�, c <br />(If Applicable) <br />OWNER/OPERATOR: -�bN blPTL�1Sk c LIPLL�SLN(o 4-W— o <br />7 � <br />(Owns /Operator Signature) (Dare) a <br />ADDRESS: 30,5K. EL <br />(Mailing Address) <br />Sk-6ck-�Of - S?�z <br />(city) 2 (State) (Zip Code) <br />PHONE: ( 2-69 ) 9 5? �� Z� <br />EH 23 046 (Revised 10/19/98) Page 9 <br />