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• <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED �/ <br /> OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2,4C)Opk /OuT11MOvntTSHtJ rlpV5L ?" <br /> Af_ +J" , ✓(�L`( <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (laboratory) <br /> TO 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 /> BUSINESS NAME: PG f E <br /> (If Applicabfle�)IL _ <br /> OWNER/OPERATOR: LN V L- l <br /> A-L6 �Yl)t0CNV � �t� Sptzl�t.Si <br /> i (Please Print) (Title) <br /> Q 03 ( ot, Q� <br /> - j (Owner <br /> /o <br /> perator Signature) (Date) <br /> ADDRESS: <br /> 37K <br /> (Mailing Address) <br /> UJA-L-Mul- CA-&E-k- <br /> (city) <br /> A-&E-k <br /> 1 (City) q (Stare) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 08/13/99) Page 9 <br /> I� <br /> 1 <br />