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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 />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 50600 (�/2 At TiOUDW k8. '1_[�Ai'_ `1 <br />n (Street Address) (City) <br />HEREBY AUTHORIZE L48 <br />(Laboratory) <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 />(Lf Applicable) <br />OWNER/OPERATOR: CLN�M - wA y , Me- (IZO� IDCN!" <br />(Please Print) (Title) <br />(Owner/Operator Signature) (Date) <br />ADDRESS: qzo (�i <br />(Mailing <br />& <br />Mo;�)ce,m C4 (75358 <br />(City) (State) (Zip Code) <br />PHONE:( 2D5 ) <br />EH 23 046 (Revised 7/10/96) Page 9 <br />