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Sent By: Equiva Services LLC; 925 957 0903; Mar -29-01 7:40AM; <br />Wedno5d2y, March 26, 2001 10:26 M www.EFEStofee.com (209) 941.4559 <br />SAN )OAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 465 3420 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />" GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1. T14E UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LUCATED AT <br />(Street Addrrss) (Crty1 <br />HEREBY AUTHORIZE P\ MS Cy ~ � <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALY'T'ICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />Page 2/2 <br />p,03 <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT 15 AVAILABLE AND AT THE SAME <br />TIMI 11 IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: y \ L --L-;> r - <br />(If Applicablr) <br />OWNER/OPERATOR: <br />(please Print) (Title) <br />(O g�>itA' Signature) <br />2 --*, (--�\ <br />(Duce) <br />ADDRESS: 1 -12Th 0 -1,i 1 b �. <br />(Mailing Address) <br />(city) (Stare) (2W Code) <br />PHONE. (�i�. S"Z-R - _ <br />EH 23 046 (Reviscd 08/13/99) pA8e 9 <br />