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i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />_OCATED AT 7_ �_ % (L1 1= I,L\�� >`t� N \ S 7 R E'�L 7 S i n Ly, k o <br /> (Street Address) (City) <br />-1EREBY AUTHORIZE `- t C)I \ )\ N c,%\\\ L� L,\ <br /> (Laboratory) <br /> t0 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> iEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: [/7 kr( — 7 M - — <br /> (If Applicable) <br /> OWNERIOPERATOR: Cn ,�� I:� n,� \F k <br /> (Please Print) (Tule) <br /> lP — F U \ <br /> (Owner/Operator nature) (Dare) <br /> ADDRESS: N 7 E 2, LVA �UCo <br /> (Mailing Address) <br /> 542 <br /> (City) (Stare) (Zip Code) <br /> PHONE: 2 4 4 Z,7 <br /> 123 046 (Revised 10/19/98) Page 9 <br />