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12/1li/2003 14:24 4640138 ENVIRONMENTAL HEALTH PAGE 06 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)46&3420 <br /> AUTHORIZATION TO RELEASE <br /> •ANALYTICAL RESULTS <br /> •GEOTECHNICAL DATA <br /> " ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> /q7�5 �) <br /> (Street Address) (City) <br /> HERESY AUTHORIZE ee <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br /> BUSINESS NAME: Lt Lal ( �'P <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (Please Print) (Title) <br /> /) y (Owner/Operator Signafure) (nate) <br /> 1g <br /> ADDRESS: 75 / l f))e)ell <br /> (Matting Address) <br /> QA q537& <br /> (Cary) (State) (Zip Code) <br /> PHONE:(Z2�,�'�l'T <br /> EH 23046 (Revised 1/24/02) <br /> 6 <br />