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SAMAQUIN COUNTY PUBLIC IIEALTH SERVICES <br /> ENVIRONMENTAL IIEALTH DIVISION <br /> (109)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1, TIIE UNDERSIGNED OWNER AND/OR OPERATOR OF TILE PROPERTY AND/OR FACILITY <br /> LOCATED AT Lincoln Unifiedr�School District Maintainence Yard 6749 Harrisburg Place- Stakton <br /> HEREBY AUTHORIZE Geo.AgLTM`k1," ahoratories (City) <br /> (LahonsMry) <br /> '10 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIEAL'I'If SERVICES-ENVIRONMENTAL IIEALTII DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> 'I IME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: �L• /106D1 ,4) o�CNoOL Q/6Ti�->C 7 <br /> (if Applicable) ^� Q <br /> OWNER/OPERATOR: �,apgpj d qP—'T ` ` �'` . QUPT. <br /> (Please P t) (ITde) <br /> ftNM7a� <br /> er/Operator Si a ire) (Dote) <br /> ADDRESS: 4©/C-) JJ) •�j�/a l/V <br /> (Hailing Address) <br /> (City) (State) Op Code) <br /> PIIONE: ) <br /> Eil 23 046 (Revised 9/11/96) Page 9 <br />