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OCT-14-2003 11:40 ENVIRONMENTAL MGMT 925 867 0241 P 02 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (304)4.68-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHMCAL DATA <br /> * ENVIRONMENTAUSITE ASSESSKSNT.INFORMATION <br /> I.THE UNDERSIGNED OWNER ANIVOR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT /8I� GnLI=Y Vim. L4 . <br /> reel Address) (City) <br /> ( <br /> HEREBY AUTHORIZE M� ' <br /> (Laherratoiy) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS ITIS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: C' <br /> (If-4pplicable) — <br /> OWNSWOPERATOR: VAC, l A1v 0P- Taa+-}`L 1 e' ! gal » EFNV d 1�td frAeGi`�l°'T t• "T' <br /> (Please Pring (True) _ <br /> . Q <br /> (I�x%erlOpe4tor619. ej (Dare) <br /> ADDRESS: 2GC70 Aemr -f a, 9ZP011.1 <br /> (Mailing-Address) <br /> (01y) (State) (Ztp Corte) <br /> PRONE: <br /> SH 23 045 (Revised 08/13199) Page 9 <br /> TOTf=L F'.0:' <br />