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V(.;1 b� '98 03:43PM CKE R&M 714 498 3667 <br /> . P.1/1 <br /> 1 r. <br /> Y# <br /> SAk...3AQUIN COUNTY PUBLIC HEALTH SE>,, L ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> i. • GEOTIrCIINICAL DATA <br /> • ENVIRUNMEN'TAU5I'1'E ASSESSMENT INFORMATION <br /> j <br /> I,'1'IIE UNDERSIGNED OWNER AND/Oa OPERATOR Or THE PROPt:ltTY AND/OR FACILITY <br /> LOCATED AT _ i3bQ MLIl0 h S-t. , MA hi &c9, GA , <br /> (Sireer,4ddress) (City) ' <br /> f f1ERE8Y AU111URIZE GeoAnalytical Laboratories <br /> t <br /> (Pahn�ntnry) <br /> Tta RELEASE ANY AND ALi, ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIFALTII SERVICES-ENVIRONMENTAL IIEALI-11 DIVISION AS SOON AS IT IS AVAILABLE AND AT 'THE SAME <br /> TINIF IT IS PROVIDED TO NIH OR MY REPRESEN'JATIVE. <br /> PUSINESSNAME: C•ari Kgrchar Eh`�G►^ pr�sr,5 <br /> (I Applicable) j <br /> OWNER/OPERATOR: <br /> (P ease P',inr) M1t1e) <br /> ( g rare) (Date) _ <br /> ADDRESS; 3 0 1 N. Lam o h St;. <br /> (,lfnilln,I ,lddrtss) <br /> (01y) -- (Slate) (Vp Code) a <br /> t <br /> �11or1�: 71 q ) 7 7 4 <br /> Ell 2J 1146 (Revised 9/11/96) Page 9 <br />