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Dec-21 -98 02 :02P Larry P­rtton 916 689 -6577 P .03 <br /> NEW �w <br /> 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 /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1. THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT IljAu we_* E:ynr rsm.le led J(ocic <br /> (Strew Address) (City) <br /> HEREBY AUTHORIZE SCi 1 <br /> ( 7) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT 15 AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: K:ng SS(c.-.d 0Zt,_ <br /> (if Applicabk) <br /> OWNMOPERATOR- -T i Mr Its IS&@ 1 r,,Q <br /> e <br /> ( ) . (I'vlq <br /> I Y DeR- -%r <br /> otoor Sigma) (Date) <br /> ADDRESS: _ sr.536 (.tles4 E.,g)ps rni l2acr <br /> (Mailing Address) <br /> S 4-oc_y: t c, Va I's <br /> (Ci(y) (Srau) Op Code) <br /> PHONE: ( ? ) ?'L S -/c`t! --- <br /> ER 23 046 (IEevised 1Ot19r9g) Page 9 <br />