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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 />* ENVIRONMENTALISITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT �SZ 3 <br />(Stns <br />HEREBY AUTHORIZE <br />(City) <br />(Laboratory or Ca adtant) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE <br />BUSINESS NAME: <br />(If Apptuabk) <br />O WNER/OPERATOR: <br />aaaL <br />I <br />�5 <br />ing Address) <br />PHONE: (/�,iq ) Hill s l r� 7 <br />DATE: <br />EH 23 041 (Revised 7-10-92) Page 9 <br />(State) (Zip Code) <br />MAY 2 2 1995 <br />ENVIRONMENTAL ERMILTH <br />SERVICES <br />