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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DMSION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND//OR OPERATOR OFFA <br />THE PROPERTY AND/OR FACILITY <br />LOCATED AT l �Q-1 JJc, 2,kF PPA ID V Ig)c-K -oN <br />(Street Address) (� (Cin <br />HEREBY AUTHORIZE f RFCiS;.nn �n"„I'n — /P(!i <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: F S 70 w <br />OWNER/OPERATOR: <br />ADDRESS: <br />(If Applicable) <br />(Title) <br />♦nn <br />(Owner/Operator <br />-STO CK rp n l CIq UIQ 2 o� <br />(City) (State) (Zip Code) <br />PHONE: (7G'] Z y / - 2-370 <br />0 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />