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III I q <br />1111 40 6 '1, <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <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 />LOCATEDATt(00,a- ts. SiDct-io/l ICA— <br />(StreetAddress) "-J (City) <br />HEREBY <br />AUTHORIZE <br />m <br />(Laboratory) <br />BUSINESS NAME: Wifffmv, ujakv CO - <br />(If Applicable) <br />OWNER/OPERATOR: <br />(Please Print) (Title) <br />(Owner/Operator Signature) (Date) <br />ADDRESS: 004;��\ <br />(Mailing Address) <br />W -0 V,) CA- Iq 511. <br />(City) (State) (Zip Code) <br />(�� �11. <br />PHONE: <br />EH23046 (Revised 8/1/11) 8 <br />