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0 152 <br /> SAN J0AQ1 TIN C01 WIN PUBLIC HEALTH SERVICES <br /> ENVIRON74EN TAL HEALTH DIVISION <br /> Qog)468.3420 <br /> AI rrH()RIZA 10N TO RELEASE <br /> Tank 827—DlUl <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> •ENVIRONMENTAL/SrTlr ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED ATCorrel Hollow Road,(�Qndiwect orTracv).Caliromia <br /> —(Srreu Address) (Cue•) <br /> HEREBY AUTHORIZE, CALIFORNIA LAI30RA'PORY SERVTt"F:S <br /> (Luhoruron or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS rr IS AVAILABLE AND AT THE SAME TIME rr IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: Lawrence Livermore Natio al Laborntory <br /> UJApplicahie) <br /> OwNER/OPERATOR: C Smi lack<on. Oamcr <br /> (P/tvsePr�ZY ��u1ec ^� <br /> (Owner/Operator Signature) <br /> ADDRESS: 7(X1(1 Fact Ave_. P_O_ Boz 808 <br /> (Mailing Address) <br /> 1 iverm ore- rA 9-1450 <br /> (Cin•) (Score) (7rp Code) <br /> PHO'N'E: (ijo) 421-6572 <br /> DATE: <br /> EH 23 041 (Revised 7/10/92) <br /> 9 <br />