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SAN JOAQUIN COUNTY <br /> `ENVIRONMENTAL HEALTH DEPARTMEN - <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED OWNER�AND/OR OPERATOR OF THE PROPERTY ANDD//OR FACILITY <br /> LOCATED AT /(7 ®V �/S/L �� D i�i✓ �� S/ ^ �DG/l /r/� ��A• <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE 5zm",j�/` TC� <br /> [ (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: Alll <br /> (IfAjplicable) G J 9 <br /> OWNER/OPERATOR: C% l� Ol' S/C/C/�T ✓ DCf/��/Z <br /> (Please Print) (Title) <br /> —�7bwner/OperatoSignature) lie ADDRESS: � 7� � Al✓t/ 'Ez i)Dli�t _/JD <br /> (Mailing Address) <br /> 7 (City) (State)) (lip Code) <br /> PHONE: D 3 [ — <br /> EH 23 046 (Revised 3/15/02) Page 9 <br />