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'A1t lu <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />`ANALYTICAL RESULTS <br />' GEOTECHNICAL DATA <br />' ENVIRONMENTAL/SITE ASSESSMENT INFORhIATION <br />I, THE. UNDERSIGNED 0,AWEER NAND/OR OPERATOR OF THE PROPERTY AND,'OR FACILITY <br />LOCATED AT C::71 %J57 <br />(SL•aa/ Ac4i•assJ ice,.. <br />HEREBY <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTN.ENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br />BUSINESS NAME: <br />0WNER/0PERAT0R- <br />0 <br />ADDRESS: /[*J L 5 0 i" -LS O ©. <br />,,� <br />j(009 / Llware/ clip cod¢j <br />PHONE: (Ic E L`T ) .,l^ � 00 / g 3 <br />EN 23 046 (R<v sed 8/9/06) 9 <br />