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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <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 <br />-A 'A 6C) ►a 1a --5,'T L.AWE . '5-CoG -'rol� <br />(Street Address) ((-IiY) <br />HEREBY AUTHORIZE �� Z�V12raJY�1E}1!ZArL <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 NANIE: UAy 5 rvtj l MA4gFC <br />(If Applicable) <br />OWNERIOPERATOR: -JH 9 MAtL y �d `L z� 0(A)AA545 <br />(Please,Print) (7itle) <br />Signature) <br />ADDRESS: I"s NA'yY PAWL <br />(Mailing Address) <br />®®-//'. <br />(Date) <br />'5Z® C,*c ` 65'? . <br />(City) (State) (Lip Code) <br />PHONE: (_1::0q <br />EH 23 046 (Revised 7/10/96) Page 9 <br />