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K. . <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 O <br /> _ PERATOR/OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT /77/17. y.I. <br /> (St ree' duress) (City <br /> HEREBY AUTHORIZE <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: uba( <br /> (if Ap licable) <br /> OWNER/OPERATOR: L,/ . zr �+ u <br /> (Please Print) (Title) <br /> ,4i <br /> (Owner/Operatt�or 5ignarure) (Dare) <br /> ADDRESS: Z / hify /oZ 2,) ! <br /> (Mailing Address) <br /> Tiow ��- "to <br /> (Ciry. (�QQ 11 (Stare) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />