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08/12/2002 13:39 2094683433 FIFTH FLOOR PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)46&3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> ENV RDNMENTA71S1TE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 3:)3 fZ��r r S"� ��TjCrLT� <br /> {StreetAddress) (City) <br /> HEREBYAUrHORIZE <br /> (Labo Lratarp) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: R —T72,,,St <br /> (If/AAppplicable) <br /> OWNEWOPERATOR: ( `� I� ��1 � '— �P� '� /` ��fl✓/�(�rl� <br /> (PI ntJ Mde) <br /> I? 03 aL <br /> (Owner/Operator Signatu (Date) <br /> ADDRESS: 303�7_ 5 Z(Z o�tY( iaOl� <br /> (MatlingAddress) <br /> -5>/aC.CT� / Ya <br /> q (City) (State) (Lip Cade) <br /> PHONE: //(z J l , `/ O~ y <br /> EH 23 046 (Revised 3/15102) Page 9 <br />