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11/30/2001 17:30 209463 FIFTH FLOOR • PAGE 03 <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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANWOR FACILITY <br /> OY, uDun m Cw (moa ", 2•l �\u� Ewat el�y &� •,Flwy 33° <br /> LOCATED AT (a="1(Stre• 1\ xJ-�p,s XB: a gp2�y G �e�v S> 7KAGEy � <br /> ( et Address) (City) <br /> HEREBY AUTHORIZE COLUNKB\A ANALy -Tke &NJ LES <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH 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:, <br /> (If Applicable) <br /> OWNER/OPERATOR: P G, L I tJ D A Cn o N SA UV E S <br /> (Please print) Mtle) <br /> Z" d,,J�evli dy, ems 12--13 /dl <br /> (Own tar Signature) (Date) <br /> ADDRESS: 3"1 5 Iy o RT VA W\ G i E T L A N E S V \7 E 2 0 0 <br /> (Mailing Address) <br /> wALNuT CREEK Ck g459g - 2412 <br /> (City) (Slate) (Lip Code) <br /> PHONE: ( 1 !5 q -7 4 — It 0 g I <br /> EH 23 046 (Revised 08113)99) Page 9 <br />