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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONIMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> ' GEOTECHNICAL DATA <br /> ' ENVIRONNIENTAIJSITE ASSESSVfENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF HE PROPERTY AND/OR FACILITY <br /> LOCATED AT --5 "7 r1 <br /> (Srrzet Address) (Crrq <br /> HEREBY AUTHORIZE �Vius f✓� a S ��� <br /> (Lcaorarorj) <br /> TO RELEASE ANY AND ALL ?.NALYTICAL INFORMATION TO SAN JOAQUTN COUNTY PUBLIC <br /> HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS .AVAILABLE ?ND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> Qf ADailCCOle) <br /> OWNER"OPERATOR: <br /> (?!ease ?rinr) <br /> i <br /> � i1l 4 <br /> (Owner/Operator SiaTdarre) ,(Dare) <br /> ADDRESS: /350 <br /> (b4eiiing Address) <br /> (Ciry) (Stare) (Zp Code) <br /> PHONE: 2 <br /> EH 23 046 (Revised 7/10!96) Page 9 <br />