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' t • •SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 /! /� � �• L-(/G(�� � �rl'C��y�C�`!I�� /Zl/• ��/� �� - <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> [� (L borate ry) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMAT'ON TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRE'-',ENTATIVE. <br /> BUSINESS NAME: 2 <br /> (IfApplicable) c <br /> OWNER/OPERAT �C /S <br /> V(Ple nn (Title) <br /> (Owner/Operator Signatur/e)`' (Date) ,�J <br /> ADDRESS: // ,/z 9 .� C—ff�[, � S C��� a✓/C? /Cl%• <br /> (Mailing Address) <br /> �e�/ Com• � S� �l� - <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 3/15/02) Page 9 <br />