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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 INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATEDAT/I/E tornrref /<j/p7E.sf.tfi�.fw voZG LiG <br /> (SrreelAddress) ---- <br /> HEREBY <br /> AUTHORIZE 7L <br /> (Laboratory) — <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: CAI 7,4,9i&5- –C& Orpte tt T+mss•?,,. {/ <br /> (If Applicable) <br /> OWNERIOPERATOR: Cleqcwcrl- C j /edFoo e•eA,r4[7 <br /> (Plea Print) rile) <br /> (Owner/Operntor ignahrre) (Dole) ��---- <br /> ADDRESS: rrS S" /1 Sfr[t f St.1 rbc a0 o <br /> (Mailing Address) <br /> Fresno C-& <br /> (City) (State) (ZeryCride) <br /> PHONE:( ._S%) <br /> SPR . 5. 0. E c�cova�83S5d <br /> EH 23 046 (Revised 07/17/14) 8 <br />