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i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 'i. (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENTINFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> 24124 N. BRUELLA ROAD, ACAMPO, CALIFORNIA 95220 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE MCCAMP(3ELL ANALYTICAL <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 SAME <br /> TIME.IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: LIBERTY FIRE DISTRICT <br /> ((j Applicable) <br /> OWNER/OPERATOR: LIBERTY FIRE DISTRICT <br /> (Please Priv ) (Title) -� <br /> ( er/0Pe ator S'E iature) (Dare) <br /> FIRE CHIEF STAN S IFERT <br /> ADDRESS: 24124 N. BRUELLA RD. . <br /> (Mailing Address) <br /> QCAMPOSAI It FD tvR IA 9522n - <br /> (City) (State) (Zip Code) <br /> PHONE: ( 209 ) 339 1329 _ <br /> a. <br /> FFI 23 046 (Revised 08113/99) Post 9 <br />