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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> i <br /> * GEOTECHNICAL DATA j <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY;AND/OR FACILITY <br /> k <br /> LOCATED AT 3 3 3 0 <br /> (Street Address) l � { (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) ;{ <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> �a <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: 6l� rJ1 A' <br /> 416-Il,�v?7 � z3 C- <br /> (If Applicable) 99 <br /> OWNER/OPERATOR: ' = L(.� r �' �' [. t - <br /> (Please Print Mule) <br /> k:�6 <br /> (Owne Opefor Signature) (� 4 (Date) <br /> / <br /> ADDRESS: 3� 0 lTC1� Ag--f <br /> (Mailing Address) <br /> CA S-DO <br /> (City) (Stare) (Zip Cade) <br /> PHONE: q 3 F(e to(P <br /> ( �] } <br /> EH 23 046 (Revised 10/19/98) Page 9 <br /> I� <br />