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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 AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 4950 304ctm kidem l (A <br /> ,+ (Screef gess) (city) <br /> HEREBY AUTHORIZE (xP�pMQ 14 tl CCL <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SA,VIE <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/ , , `-H �1 J <br /> GeZ11 -L/( C V <br /> (Please Print) Critle) <br /> X ` ��I � � L <br /> (Owner ig re) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Cade) <br /> PHONE: (� <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />