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ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />F., "I V Me m *A V*fll I I M <br />* ANALYTICAL RESULT'S <br />* GEOTECHNICAL DATA <br />la-gol nxi F.% 6 cou <br />-7 <br />14 <br />LOCATED AT �Oao_u <br />(Strect ddress) V I (city) <br />HEREBY AUTHORIZE PxXf �ru(cL-.j <br />(Laboratory or ComuUanl) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />BUSINESS NAME: pacl-li-t <br />T n1i -fTlTzppp <br />DATE: <br />(city) (State) (Zip Code) <br />• <br />I I <br />EH 23 041 (Revised 7-10-92) Page 9 <br />