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07/1.6/04 08:17 FAX 925 422 2 EPD / WGMG • X1014 <br />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 />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT k- U5 194 - <br />(Street 94(Street <br />HEREBY AUTHORIZE <br />i <br />(City) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION 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 />REPRESENTATIVE. <br />BUSINESS NAME: 1,4Wrrhte 1,►f/PrvnyCe1&/- <br />nl LR 1 o <br />(If Applicable) <br />OWNER/OPERATOR: I , e5 D-6 Jl — <br />Y <br />(Title) <br />(Owner/Operator Siglo ur� (Date) <br />(Mailing Address) <br />I-IVPrmOr-C, C O£'o� <br />(City) (State) (Zip Code) <br />PHONE: (_ a ✓3 —'� <br />EH 23 046 (Revised 10/16/03) Page 9 <br />