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� s <br />SAN''JOAQUIN Envir i It <br />IVED <br />COUNTY <br />AUG 2 i 2018 <br />AUTHORIZATION TO RELEASE E4njiRnNMENTAL HEALTH <br />* ANALYTICAL RESULTS DEPARTMENT <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNNED OWNER AND/OR OPERATOROFTHE PROPERTY AND/OR FACILITY LOCATED AT <br />(Street Address) (Citi) <br />HEREBY AUTHORIZE <br />(Laboratoq) f /b -,kb / - O `tihO <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br />SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(If Applicable) <br />OWNER/OPERATOR: <br />Jose Rios <br />(Please Print) <br />Signature) <br />Mgr, Environmental Services <br />(Title) <br />08/06/2018 <br />(Date) <br />ADDRESS:— ot-e-&L, Ste, 4 0 - V4, Z1 ` Ze ��4 5 <br />(dfailingAddress) <br />(009 <br />PHONE:( 72-82§-6592 <br />8of10 <br />(State) (Zip Code) <br />