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' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT !Prl � d1, <br /> ' (Street Address) (City) <br /> HEREBY AUTHORIZE /+ )) I/ ,f <br /> fl nk L0.b/rc, f! Servf e <br /> ' (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> ' DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE <br /> BUSINESS NAME U n I G(f'S�` �ca un G1r+� <br /> (IJApplicable) <br /> OWNER/OPERATOR <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS e 1 R Al tivr1 L-c fr <br /> (Mailing Address) T <br /> (Ci(y) I I (State) (Zip Code) <br /> ' PHONE ( 209 )� 9 I(-9 3�� � ..,,....... <br /> EH 23 046 (Revised 3/15/02) Page 9 �L �l Z <br /> 1 <br />