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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT ��06 �Ilys CA lam, <br /> (Streetess) (City) <br /> HEREBY AUTHORIZE OZA4 Kiq <br /> L1L� <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: I I f_D ,1C1 j e7 <br /> (If Applicable) <br /> OWNER/OPERATOR: J 04 94 J4 t k4-W e t 1 <br /> (Please Print) (Tale) <br /> X <br /> caner/Operator Signature) (Date) <br /> ADDRESS: SO&& (61 t i' <br /> (Mailing Address) <br /> 157e,L4 {rt1 QA- 4L:-%to <br /> (City) (Stare) (Zip Code) <br /> PHONE: -3 T,'T i O b <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />