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SEP 03 '97 09:35 USA PETROLEUM POMONA 714 6221002 <br /> • <br /> SAM JOAQIIIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)469-3QO <br /> AUTHORIZATION TO RELEASE <br /> "ANALYTICAL RESULTS <br /> " GEOTECHNICAL DATA <br /> BNVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANDIOR FACILITY <br /> LOCATED AT_ 07 <br /> 1:1,11. 00 -1. (.ea C <br /> HEREBY AUTHORIZE ,$,S I) ) <br /> 60 (CJtyJ <br /> TO RELEASE ANY AND ALL ANALYTICAL (Laboratory) o A4 kr <br /> HEALTH INFORMATION TO SAN)OAQUIN COUNTY PUBLIC ' QLbS 3 <br /> S$RVICE' 'N'VIRON MENTAL 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: (Ag <br /> {If+IPPumble) ' <br /> OWNERIOPERATOR: <br /> Cori <br /> (Piedra Prim) a` <br /> tJe) <br /> ! eupnerlOparaJor S�rtatan) <br /> ADDRESS: ! Z{o J �r (Dare) <br /> P6 <br /> � 7loL <br /> (Srate) rap Code) <br /> PHONP: (!�p�f 1 r� <br /> A. <br /> EH 23 046 (Revised 9!11)96) <br /> Page 9 l: <br /> f <br />