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Dec 28 07 04:05p Bev (20962-9861 p.1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> " GEOTECHNICAL DATA <br /> * ENVIRONNIENTALISITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER ANDD/OR OPERATOR OF THE PROPERTY AND/CR FACILITY r <br /> LOCATED AT 43 J 6, S/• S C C/CJat l <br /> (Street Address) (Cif}) �ny <br /> HERESY <br /> AzrrIIORIZE ,1f�Q _ � /3(/�Z�¢ r� _ CF!fE S (-r9: 95 �d7 <br /> (Laboratory) Z O 9 57/ J`''L <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOONAS IT IS AVAILABLE.AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> / S'/ 2L S 7. <br /> BUSINESS NAME: ` r-;4 A)C66-L) OF- S 74KG/217n) 2� F1'/ S CG41- C L61W,(C/f <br /> (If Applicable) <br /> OWNER/OPERATOR: 1u.1. GIAJ AJ <br /> (P �Pr, (Tule) <br /> / o? <br /> (Operat gnaturc) (D re) <br /> ADDRESS: -34/ U L 190�/J <br /> Address) q <br /> CJ(city) (State) (Zip Code) <br /> PHONE:( / ) % f/(% 5-3 I <br /> EH 23 046 (Revised 8/3/07) 9 <br /> I <br />