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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE p / y <br /> d1 Ceo LMVI }' o "'m 9- <br /> (Laboratory) <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 <br /> TIME IT ISPROVIDEDTO ME OR MY REPRESENTATIVE./ . <br /> �0 1J 7Y'a c Gy'S - <br /> BUSINESS NAME: <br /> '►M <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> Please Print) (Title) <br /> (Owned iator Signature) (Date) <br /> ADDRESS: -3 1V u-�Gt. ?YL J <br /> (Mailing Address) <br /> 5T_/L <br /> (City) (State) (Zip Code) <br /> PHONE:(tea <br /> I <br /> EH 23 046 (Revised 1/24/02) <br /> I <br />