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94 JOAQUIN COUNTY PUBLIC HEALERVICES <br /> ENVIRONMENTAL HEALTH DN BION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> 865 DWI <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 'Isv""•:: .T=C°alumx a <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFO TION TO SAN JOAQUIN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TMM IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: Jim=t• m.,.,,o AT *mW t ahnrd= <br /> (If Applicable) <br /> OWNER/OPERATOR: Harry Galles, Owner <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) <br /> ADDRESS: -7mug°Mn0 BOX%a <br /> (Mailing Address) <br /> Liverrrse.CA 94550 <br /> (City) (State) (Zip Code) <br /> PHONE: 610} 423-7983 <br /> DATE:_ <br /> EH 23 041 (Revised 7/10/92) <br /> 9 <br />