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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 469-3420 <br /> A=ORI.ZATI©N TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * EINVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 3 S' Tf{ TGYrf'7��G` -5�i'��E <br /> (Street Address) (C4) <br /> HEREBY AUTHORIZE �'aF0 tiAL-�1T/G.�4L — 4e—o <br /> (Laboratory or Consultant) <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: -1NTEteT7f7 f 7A(el< c`5.f,5fiy; CO,Pl> <br /> (If Applicable) <br /> OWNER/OPERATOR. pe"k" IkIln 5erljttce, mu,. ger <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) <br /> ADDRESS: 113-7 Aou%� Y7-me7a tl <br /> (Mailing Address) <br /> Y-mwre ell- <br /> (City) <br /> '�(City) (State) (Zip Code) <br /> PHONE: <br /> DATE: /_ �r �3 <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />