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SA N 10 A Q U I N Environmental Health Department <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> *EN'VIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/ F CILITY LOCATED AT <br /> �� <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <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 TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: t/!9!✓��2�yVO�'/�A C <br /> ff (IfAppl iicable) <br /> / <br /> OWNER/OPERATOR: /7 Y//c/T <br /> (Please Print) (Title) <br /> -3 2 ° <br /> (Owner/Operator Signature) (Dale) <br /> ADDRESS: S V, /lt/Ielly S;� <br /> (Mailing Address) <br /> s?,*0"C�t?oo 6�5�Z03 <br /> (City) (State) (Zip Code) <br /> PHONE:(�� ��5-0 <br /> 8 or 10 <br />