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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 /> pge6t-for <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT I)o? N je`1 -IDOradO �JAYea4 5+OGLton <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE is I G2 a <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: 76o *_ 4409 <br /> (If Applicable <br /> Alen+ for <br /> OWNER: 914L Cign &roup Inc, Champ &ianiho� PW L00rd • <br /> (Please Print) (2-itle) <br /> /Operator Signature) are) <br /> ADDRESS: I&Wloto Pass toad `jus}e 420 <br /> (Mailing Address) <br /> Concord �a `14S2U <br /> (city) (State) (Zip Cade) <br /> PHONE: &--50D <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />