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9255517899 Line 1 C °:06 p.m. 11-04-2010 6/13 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQM COUNTY <br /> Telephone:(209)468-3420 Fax:(209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> •ANALYTICAL RESULTS <br /> •OEOTECFINICAL DATA <br /> * ENVIRONMENTAUSITE ASSESSMENT rQFORMATION <br /> L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> HEREBY AUTHORIZE <br /> GAL Sal Cc F-RV. �-AB-g, <br /> (LeLioriQtoryJ <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN IOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS TT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME . <br /> awrneR: Pn.fil � a, r <br /> (b1Ya!!SIgIl41t111S� <br /> (Malllw Address) <br /> r. <br /> k <br /> (CIO) (Stall) (dip code)- . ....,...,__....._. <br /> EH 23 046 (Revised 07/21/10) <br /> 6 <br />