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1-rlrzvMUH UZ)H rKUVU,1,:, t <br />E <br />E <br />S?"& -JUWfIjA-LVlRT'f PIOAC &Z-3--lih SERTICI <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 469-3420 <br />AUTHORIZATION TO RELEASE <br />® ANALYTICAL RESULTS <br />® GEOTECHNICAL DATA <br />q' ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br />I. THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/Olt FACILITY <br />LOCATED AT <br />HEREBY AUTI <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT 13 AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: alwlae,?Y? <br />trAppficaue) <br />OWNEFJOPERATOR: 'D c -o --o'6 t�z c ftje� <br />e (TUIC) <br />/.2 /.,w/fg <br />, or Sire) (Date) <br />ADDRESS: <br />(MaUm'g-Addroess) <br />115Z r-- L/ <br />(01y) (Sralff) Zip code) <br />PHONE:( ea- %96-3 <br />EM 23 046 (Revised 10/19/93) Page 9 <br />TOTAL P.02 <br />