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K <br />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 s /% (,( a*1_0, <br />(Street Address) <br />(city) <br />;121 -5 - <br />HEREBY AUTHORIZE & 4-- 17 U / /G <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 NAME: 0/ZXe Ido "<2-1 <br />(If Applicable) <br />OWNER/OPERATOR: <br />ADDRESS: <br />(Mailing Address) <br />�5t4ockyon CA JSa/S <br />(City) (State) (Zip Code) <br />PHONE: (c�2 b ) 13/ 07 19 y� <br />EH 23 046 (Revised 7/10/96) Page 9 <br />