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MAR, 18, 2465 3:44PM ( ORD BLDG SVCS �. NO. 0495 P. 4 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DBPARTAIENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> * FNVIRONMENTAL/SITE ASSESSMENT <br /> INFORMATION <br /> I,THE UNDERSIGNED OWNiER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT '4040 W%S'T 1_A�,E -�r_ta�to <br /> (Sweet Address) (City') <br /> HEREBY AUTHORIZE <br /> L � L <br /> (Laboratory) <br /> TO RELEASE- ANY AND ALL,ANALYTICAL TNFORMA,TION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT T14E SANTE TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: 'P+C-T �VQ C43741S Sou t CE "tVZ-�p <br /> (If',�pplieable} <br /> OWNER/OPERATOR: JQMXT�-k01.9 G PFO R-�?, �C <br /> (Please P)-int) (Title} <br /> (Owner/Operator agnarure} (pate) <br /> ADDRESS: V <br /> (Mailing Address) <br /> (Gry} (State} (lrp Code) <br /> PHONE:{ 9 <br /> EH 23 046 (Revised 10/16/03) Page 9 <br />