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u i-.wc�io roG I'.19tl <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH TH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> CM9)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ` 2'(yMONMENTALSIIE ASSESSMENT INFORMAT ION <br /> HE UND IGNED OWNER AND/OR OPERATOR OF THE PROP2TY AND/OR FACILITY <br /> y <br /> CATcD AT s; !/41zq,, /9 Wi4�/ S%fJC,L' Tint/ <br /> (Sireerdddras) <br /> REBY AUTHORIZE <br /> (Zahmnrory) <br /> RELF-ASE 14NY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> 4LLTH SERVICES-c'NVIRONMENTAL HEALTH DIVISION AS SOON AS IT USAVAII4tBLE AND AT THE SAME <br /> M IT IS PRQII VIDED TO ME OR MY REPRESENTATIVE. <br /> aUSlir-Es xAMrw` �,P�o /tip-i�i'�/ f=ry �`4t93Z S'.-ry,�Te,� <br /> (l14PpUCab4E) <br /> WNERIPPE 7,ATO9 131cL I7&-PZ 4.7"9 7- �QPco Fif�> �,�Ri�✓c p <br /> "Woe'FOpwator Sigtr=ur) e) <br /> DRES�7 /zt� <br /> EL,/C �2r�dE �q �S 7sR <br /> rt�tyl (S=4) Zp Cade) <br /> IPHoNE: <br /> 46 (Revis�d 10/19/98) Page 9 <br />