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8/THU 04: 3b YM GOS h HEVIE <br /> 0/2008 xK0 14:22 FAx 7094683433 SSC FHb <br /> ENVIRONMENTAL-HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)46.8.3420 Fax: (Z09)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAI.ISITE ASSESSMENT INFORMATION <br /> I,THF-UNDERSIGNED OWNBR AND/OR OPERATOR OF THE PROPERTY AN.01OR FACILITY <br /> LOCATED AT 1 , . c, a iL- S <br /> (Street Addrws) ( '� <br /> HEREBY <br /> AUTHORIZE 1`,l �§ \"_ w ri(r.a L <br /> . bnrrrlory) - <br /> TO RELEASE AN'Y AND ALL: ANALYT CAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS TT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME-01Z MY RWRESL-NTA,TIVE. <br /> BUSINESS NAME: Q I o. r ct�t 1. +i�`Lv� wn.,� fQ l3�•f <br /> IApp&xible) <br /> l Z N �l4V�l <br /> OWNEI2/OP1rRATOR: %to� '� � `1 l► <br /> 0 <br /> (off. ++1st).-.'. <br /> ADDRESS: 47-• L� 1b - ;� WNW <br /> (MaMng.4ddress) <br /> � y) (State) (Zip Code) <br /> PItONB: Zci ) 3V1 7 <br /> 13,1423046 (Revised 07/31/08) 9 <br />