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8/THU 04: 36 PM COS H,2G, & REDN'�I <br /> 1/20/2008 WKV 14122 FAIL 209W433 STC glib <br /> 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 /> • ENVIRONMENTAIISJTBASSESSMENT INFORMATION <br /> ' 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANA/OR FACILITY <br /> ' LOCATEDAT 1 . [. oth <br /> (S(tr=l Add=) (Gly) <br /> HEREBX tryri(-6a� <br /> ��,\ C{ 1. <br /> AUTHORIZE ( <br /> .(Labar•aJary) <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 OIL MY REPRESENTATIVE. <br /> 1 <br /> BUSINESS NAME: C i <br /> jAppticab7e) <br /> OWNERIOPBRATOR: x Rek i'ti r -�� ltlel <br /> rmo <br /> (ownltafure)--. ((Date) <br /> ' ADDRESS: 442 y"- hI, l5t DcH«l�u �1-, -['k <br /> (MaM.gAddres) <br /> $'z.0-LL _ <br /> ( c (State) Zip Code) <br /> (aY) <br /> P1iONE:LLa—) <br /> 1 <br /> r <br /> ' EH 23 046 (Ravised 07/31/08) 9 <br />