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: 1 1 f: OCPti� T' F t No. 0812 P. 2i2 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 46&3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> "ANALYTICAL RESULTS <br /> *GEOTECKNICAL DATA <br /> * ENI VIRONMENTAI)SITE ASSESSMENT INPOK+IATION <br /> 1,THE UNDERSIGNED OWNER AM1M/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCAIED AT 315 E. 11th Street, TracY, CA <br /> (Street Address) (C)3Y) <br /> ,,, <br /> AUR OILIZE / ` • FI �/L) /7 L--T L �� <br /> (L4borawry) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE.AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR-MY REPRESENTATIVE. <br /> BUSINESS NAME: v.. TAY Unified School District <br /> (IfAppliceble) <br /> OWNER/OPERATOR: D2hlC p. Uceg1 f OL E2 t <br /> (Please Prtnr)"70 (IYtle) <br /> caner/Operator Signature) (Date) <br /> ADDRESS: 1975 Went LOwall Avenue <br /> (Matting Address) <br /> TYacy, .CA 95376 <br /> (City) (Stare) (7.1p Cade) <br /> PHONE:( a Q! <br /> EIJ Z3 046 (Revised 11/21/06) 9 <br />