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NOV/20/2008/THU 04: 36 PM COS & REDEV FAX No, 2099379 P. 006 <br /> -..._—"".........._"'_.-__.._.- . X006/006 <br /> 11/20/2006 xaV 14:22 FAX 2096683433 STC EaD <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> TelepBone: (209)468-3420 Tax: (209)468-3433 <br /> AUTFIORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> «GEOTECHNICAL DATA <br /> • ENVIRONMENTAUSITEASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THEPROPERI'Y AND/OR FACILITY <br /> LOCATED AT t. cit– <; `cac � <br /> (Street Addrvss) (Qty) <br /> HEREBY <br /> AUTHORIZE �+� � t^1° aRb <br /> (Lrtborrslory) ' <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: GiT`1 tel' ��cr�To" Z-AAU%jt�`p�� rr' IQSU�'c }— <br /> tArnitcable) <br /> % <br /> OWNER/OPERATOR: w%� i'r�' ?-�� ide) <br /> lino <br /> (Own IeI t iwture) ((Date) <br /> ADDRESS: 47-- h, Ca c Ab Y- -G \ <br /> (MaitingAddrem) <br /> IC.A �K 5 -2-v;L <br /> 1�r1 _ <br /> t,c� (State) (Zip Code) <br /> PHONE: <br /> C•IJ 23 046 (Rcvised 07/31/08) 9 <br /> I <br /> I <br />