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SANJ O A Q U I N Environmental Health Department <br /> -- COUNTY - <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * <br /> ENVIRONMENTAL / SITE ASSESSMENT INFORMATION <br /> 15 THE UNDERSIGNED OWNER AND/OR OPERATOR OF a IE PROPERTY AND/OR FACILITY LOCATED AT <br /> 7000 N Michael Canlis Blvd , French CA CA 95231 <br /> (Shw , Address) (City) <br /> HEREBY AUTHORIZE <br /> Advanced Geo <br /> (Laboratory) <br /> TO RELEASE ANY AND ALI. ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTA'T'IVE, <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER; County of San Joaquin Fleet Services �i+ A /,�►r+t� /�{ /�pl � <br /> (Please Pring (Title) <br /> daylo 4 - A .G✓ <br /> wor <br /> (Ovine ►• Signature) 4� (Date) <br /> ADDRESS : <br /> �p y s• wt i s �� w4 y STWtfi.&I 64 <br /> (Allailing Address) <br /> q �zc��' <br /> (City) (State) (Zip Cocle) <br /> PHONE ; 2 V49%— y (� 17 7 �� <br /> 6of6 <br />