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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 458-3420 <br /> AUTHORIZATION TO .RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1 <br /> 1, THE UNDERSIGNEDOWNERAND/OR OPERATOR OF THE PROPERTY AND/OR FACILIT <br /> ' LOCATED AT `'''D I C d <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE SAAE � i <br /> (Laboratory) <br /> TOTO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br /> 1 <br /> BUSINESS NAME: <br /> {}f Applicable) <br /> OWNER/OPERATOR: h1 b <br /> ' (P ee se Pr t) itle) <br /> 3 AL 11,t2 <br /> ' ( veer perator Signature) (Dat <br /> - ADDRESS; <br /> {Mailing Address} <br /> (City) (State) (Lip Code) <br /> PHONE: ( ) <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />