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AA A O!V�[N Environmental Health Department <br /> COUNTYI— <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GFX)TECHNICAL DATA <br /> *ENVIRONMBNTAL/SITE ASSESSMENT INFORMATION <br /> t THE UNDERSIGPN OWNER AMID/OR OPERATOR OF THE PROPERTY AND/OR FAC XrY LOCATED AT <br /> 1022 Frontage Rd. Ripon, CA 95366 <br /> (Street Address) (City) <br /> CALTEST Analytical Laboratory HEREBY AUTHORIZE <br /> a-abonftwy) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (rfAPP��'�) <br /> OWNER: �oM S��or� 0u,i'JC4 <br /> (Please Print)� 3Iyy 1 (4'i k)1�1`j <br /> (Owner Signature) (Date) <br /> ap (' ADDRESS: <br /> S4L) '1.10b0 <br /> - (Mailing Address) <br /> (city) !ate) (zip fie) <br /> PHONE: <br /> MAR 14 2019 <br /> ENVIRONMENTAL HEALTH <br /> !�7=PARTMENT <br /> a Of 6 <br />