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SAN '1 O A Q V I I Y Environmental Health Department <br /> — COUNTY— G� <br /> AUTHORIZATION TO RELEASE ; EB 0 7 2018 <br /> * ANALYTICAL RESULTS <br /> ENViCsONCV��ER1`iA1e HEALTH <br /> * GEOTECHNICAL DATA l E.- PrttkR"('S ONO <br /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> (StreetAddress) / (City) <br /> HERE Y A � <br /> „UTHO E�V1 � I 1 tVl�r'1� i1 � <br /> (Laboratory) <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 T/O+ ,ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: cg)pC c`A�,( , � (` _— <br /> (IIfAppliceVe) <br /> OWNERIOPERATOR: <br /> (Title) <br /> 2�j / . <br /> Own /Operator Signature) (Date)' <br /> �y t <br /> ADDRESS: 4`J�J J �• i G <br /> (MailinggA�ddyress) /w <br /> 42 4jw <br /> (cityy)�)yy 9 (State) (Zip Code) <br /> PHONE: <br /> a of 10 <br />