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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 /> •GEOTECHNICAL DATA <br /> " ENViRONMENTALISITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY <br /> �AND/OR <br /> ,FACILITY <br /> LOCATED AT �(+I ;;- G `� '' -E -�`Ilzm) <br /> freer Address) /� (City) <br /> HEREBY AUTHORIZE 11, Lr D Q-e� f f�U �1TlcA� <br /> (Laboratorq) -� <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <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: <br /> (If Applicable) <br /> ,� \.t . , ,. i In f`G� d tk (5 W NECK <br /> OWNER/ PERATOR: 1` �� � �t�a-� � <br /> (Pate ) Ttle) <br /> (Owner/Operat tgnmre) (Dare) <br /> ADDRESS: ( des CkNPCmTt <br /> (Mailing Address) <br /> c��L�011 � CI S'LO <br /> (City) (stare) (Zip Code) <br /> PHONE: R �6y - 20-0 Z <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />