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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 /> " ENVIRON,MENTALISITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> "?-7 S �. ����t✓rZ� Q�c� lZ � � n�-r� <br /> (Street Addre rs) --- <br /> (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 ITIS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS TAME: h— <br /> (/fAPPNcoble)OWNER/OPERATOR: <br /> (Please _ (Tate) <br /> " * 40 c c� <br /> re) (Dare) <br /> ADDRESS- _ �-�- <br /> (Maihng address) -- <br /> Z� s rk,- --i 6?C,3 <br /> (City') (&We) r1op Co*) <br /> PHONE:( —71 <br /> EH 23 046 (Revised 1/24102) <br /> 6 <br />