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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 OWNER AMD/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT I/o P(5 Cr Aw�E (Z D. rjFa Dry l <br /> (StreetAddrrss) (City) <br /> HEREBY AUTHORIZE Cr t'0L-0('1L��- '�ec\n ni�S N L &V--Ta <br /> (Laboratory or Conadiant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVA ABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Appdcable) <br /> OWNER/OPERATOR: �-e '5- <br /> (Please Print) (Tide) <br /> 1 <br /> (OwneriOperator Signature) /) <br /> ADDRESS: p. 0 ti3oK Sofa <br /> (Maffing Address) <br /> M��ESTa CA 9535 Z <br /> (City) (State) (Zip Cade) <br /> PHONE: (&0I ) 5 Zq - 1-7SZ <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />