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SOAQUIN COUNTY PUBLIC HEALTH SICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(2 09) 468-3420 <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 />CptiN SFA °5 CAP6. k4A<5 <br />LOCATED AT {og-2 1-J ® AA-UN <br />(Street Address) (City) <br />HEREBY AUTHORIZE 5M -1G V p' ,A� ASW 1-_ L/kF <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: CA ?-A APPS `S A t:5%i <br />(If Applicable) <br />ADDRESS: 15'tP(lJ N . <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />EH 23 046 (Revised 08/13/99) Page 9 <br />