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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />. ANALYTICAL RESULTS <br />' GEOTECHNICAL DATA <br />• ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT /1p '6 / /rLf -1/e/y,71y J //L/_�& 7 l_�0E WALK I <br />(Street Address) (City) <br />HEREBY AUTHORIZE lA--'%l 5PA?AFZ 7FcNN000GV <br />(Laboratory or Con ulkW) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE <br />BUSINESS NAME: ?k GrT'ii a/= T,PAcy <br />(If Applicable) ' <br />OWNER/OPERATOR: eR PAUL VE=tm4 I1i0�CT M/17u/7k'�z <br />0 <br />(Owner/Operator Signature) <br />TIL 4 6 V. lei 95-77e <br />(City) z (State) (Zip Code) <br />PHONE:( 20� ) 934 <1q7 -Q <br />DATE: <br />/o <br />i <br />EH 23 041 (Revised 7-10-92) Page 9 <br />