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o a¢-1�I T94. tfit 43 2F iM'� NC 209 9'5�85000 c E c c H I vT 1 P o t <br />P. 2 <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />1209) 461-3420 <br />AUTHORIZATION TO RELEASE <br />'ANALYTICAL RESULTS <br />GEOTECHNICAL DATA <br />e ENVIRONMENTALSITB ASSESSMENT INFORMATION <br />I• THE VNDEMONED OWNER AND/OR OPERATOR OF THE PROPERTY ANDJOR FACILITY <br />LOCATED AT <br />HEREBY AUTHORIZE df4g44_ 41lwJ�(/__ f��j(yfyrr <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -E NVIRONXENTAL HEALTH DIVISION AS SOON AS IT IS AVAII.ASLS AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIV$, <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />WAE7A1..._.:& <br />PHONE: C -,!Vb, T- 2057 <br />EH 23 046 (Revised 9111196) PIP 9 <br />