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SAID 1(DAQI IIN C01 TNTY PIJRLIC HEALI-H SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 12tH!► <br /> W-3420 <br /> AI rrH()RIZAIION TO RELEASE <br /> Tank 827—D2UI <br /> 'ANALYTICAL RESULTS <br /> °GEOTECHNICAL DATA <br /> •ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1.THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Corral Hollow Road-Nouiliwest of Tracy) (':+lifomi� <br /> —(Street Address) (Cite) <br /> HEREBY AUTHORIZE, CALIFORNIA LABORn��� <br /> (Lahoraton•or Con-whant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSI'rtSS NAME: Lawrence 1 i cMt)r N'• n-d Lahorllgry <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (P/e Nn <br /> (Tule) <br /> (Owe-r/Oprator <br /> Sienature <br /> ADDRESS: 7M) c « e E n Rte: ROR <br /> (Mailing Address) <br /> (Cin•) (Slate) (Zip Code) <br /> PHONE: (`12) 47A-6577 <br /> DATE: <br /> EH 23 041 (Revised 7/I(J92) <br /> 9 <br />