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S.a_v JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> �. AUTHORIZATION TO RELEASE <br /> i., ' ANALYTICAL RESULTS <br /> ' GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL./SITE ASSESSMENT INFORMATION <br /> rr <br /> .I. THE UNDERSIGNED ONW.KE.R AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> rr LOCATED AT '4-300 . �L UhL(.! <br /> (S-:et Address) (Clry) <br /> HEREBY AUTHORIZE i lit—f =rtQWt12Q,4L <br /> (Laboratory or Consullaru) <br /> TO RELEASE ANY AND ALL A.�TALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PCEL:C <br /> HEALTH SERVICES AS SOON AS IT IS AVAH ABLE AND AT THE SAME TIME IT IS PROWDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: .- F4 LEL�, ' L <br /> (If Applicable) <br /> S LULL L o l �✓sFx�k S !�lsu ti 'r <br /> OWNER`OPERATOR: �,4� _ Y 1`,'�• LAG <br /> :ease r) (Title) <br /> V (b,*mer/Operator Signature) <br /> +-■ ADDRESS: 51 R , <br /> (Alading Address) <br /> (City) (State) (Zip Code) <br /> PHONE: fl �6� ' a 15 <br /> �. DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />