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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> •ANALYTICAL RESULTS <br /> •GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> �0vEL `oijourf . <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1608 <br /> C�• rlZZZ O�Q :5V" / 10A1 <br /> (StreetAddress) (City) <br /> HEREBY AUTHORIZE <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: <br /> (if Applicable) <br /> OWNER/OPERATOR: Arismf- <br /> Fi!/>vEe �ents�evc�p u ?xc. -Micba�L Ln�¢u�iC 1/f? <br /> P ase Print) (Title) <br /> au� �1 alos <br /> daf (Owner/Operator Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> eA 9Jri67� <br /> p/ (City))r' (State) (Zip Cade) <br /> PHONE:( /` ) 4/Z4�04a`� <br /> EH 23 046 (Revised 1/24/02) <br /> 6 <br />