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Jul 01 03 11:32a T T Environmental System 1 1858-1011 <br />fjl,/ j1j/7()03 IV: ffi 2 83433 171FIH FLOI.IR <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* AVALYTICAL. RESULTS <br />* GI-'OTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, If HE WDERSIGNED OWNER j\NDIOR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 5P.jeq,)"eV94)U1Ott 5T- 1,5 Te)lq <br />(Street Address) (0w <br />HER1.111Y AUI HOPJZE <br />(Laboratory) <br />PAGE t, I <br />TORELLASE ANY AND ALL ANALYTICAL.. INFORMATION TO SAN JOAQUIN COUNTY ENVIROmm-ENTALHEAura <br />DEPAP TMENTAS SOON AS IT IS AVAILA33LE AND AT THE SAME <br />TIMF IT IS PROV1DED, 1*0 ME OR MY REPIWSENTATIVE. <br />W)SfAESS NAME, <br />(if Applicable) <br />OWNERtOPERATOR- <br />--PjmALtv,�1)&C" <br />(Please Print) (Title) <br />(0 er/Operstor Sigma, <br />ADDRESS: <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />PHONE: (,gC)q ) q&g o --- <br />EH 23 046 (ReVi3Cd 1/24/02) <br />6 <br />