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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> s ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 8115 South ElDDornVrsa�do Street, French Camp, California 95231 <br /> HEREBY AUTHORIZE Upggffl ent ti ronmental Consul tants/Excel chem �onmental Labs <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME: J & L Market <br /> (If Applicable) <br /> OWNER/OPERATOR: Mr. James Fisk Owner <br /> lease Print) (Tule) <br /> (Owner/Operator Signature) ; <br /> ADDRESS. <br /> 8115 South El Dorado Street <br /> (Mailing Address) <br /> French Camp California 95231 <br /> (City) (State) (Zip Code) <br /> PHONE: ( 209 982 0897 <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page I <br />