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0 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209) 468-3433 <br /> AUTHOFJZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT .41 /%Vz1R,3, <br /> (Street Address) (City) <br /> HEEBY <br /> AUTHORIZE (5�569 <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 SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 151-?61,( !;-;��Ieild <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (Pleas Print) (Title) <br /> '2- <br /> (-(Owner/O&ator Signat&4) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> 4a�4 ' - 3 7 <br /> (City (State) (Zip Code) <br /> PHONE:C6A�0 <br /> EH 23 046 (Revised 8/1/11) <br />