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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 /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT zoo E:- P-022Z op=0,4n 1-4 224f=V_to <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE /Vj7P_71',1 <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INYORIMATION 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: <br /> (If Applicable) <br /> OWNERIOPERATOR: Lgeta <br /> .5 <br /> (Please Print) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: A 0, 6or 9604oZ 5 7-o c, foe ce,, 9.5-2 95* <br /> (Mailing Address) <br /> (city) (State) (Zip Code) <br /> PHONE: (_a2l _) <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />