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9 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE- <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION A- <br />1, <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />Address) <br />HEREBY AUTHORIZE <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />—T f Applicable) <br />OWNER/OPERATOR: 1yP 2, . ��p, � ,J �Q�� <br />(PlecAe Print) (Title) <br />4rLa,_�.r ri i <br />(Own r/Ope for Signature) (Date) <br />ADDRESS: f` //< Z � &15z-- <br />(Mailing Address) <br />, / amx% 6-77 <br />(City),�JJ (Stare) (Zip Code) <br />PHONE: (� �y'g-03D� <br />EH 23 046 (Revised 10/19/98) Page 9 <br />