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07-22-114 14;45 FROM- T-014 80007/0012 F-019 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY '6 _ _ <br /> C� <br /> j r <br /> m /� <br /> Telephone, (209)468-3420 Fax, (209)468-3433 �► .a � �` <br /> ATJT140RIZATION TO RELEASE JU L S 2 Cu ti4 <br /> ANALY'11CAL RESULTS C)apARTMENNV1RG►��y� `���` LTH <br /> *GEOTECHNICAL DATA <br /> " ENVIR.ONMIENTAL/SITE ASSESSMI T INFORMATION <br /> 1,T�W UNIDERSIGNM OWNER AND/OR OPERATOR OF THE PROPERTY ANWOR FACILITY <br /> L.00AT.ED AT 0 a <br /> (S treat rf ddress) (city) <br /> I-EREBY <br /> AUTHORIZF- <br /> (Laboralm y) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUI'N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE <br /> .BUSINESS NANffi: ,,, oft <br /> (7fApplicoble) <br /> OWNERJOPERATOR: PC's Pz <br /> (Please Print ��e) <br /> 7/22/2014 <br /> f�w �t�tpesl .ci� �t+�rre� :� : <br /> ADDRESS, + * l ' ' f' ci sae, <br /> (Al aili»g Address) —� <br /> (city) (Slate) (Zip Code) <br /> PHONE:L ( <br /> EH 23 046 (ktvised 10130/12) 8 <br />