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�, 1I <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 /> ENVIRONMENTALJSITB ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED 9MINPROWBOOR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> ROAOW,4 y <br /> LOCATED AT m GUB Si /r/2ArufLLN� 12044 (5idEvwk ) T2AN. <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE CKy 0A)t IRONMaN7-A1 SC2UiGtS, I�JC oe . VOA2lrErR ;?-e � 140 <br /> (Laboratory or Cauultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME: 7,06 Com,r y aF 7RAr-y . <br /> (If Applicable) ' <br /> OWNER/OPERATOR: /t9/Z PAULyLam,4 <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) <br /> ADDRESS: _5zl) 7-,Q.4C 5/ ACU-6 <br /> (Mailing Address) <br /> k,AC v G4 c/.573 7-( <br /> (City) (State) (Zip Code) <br /> PHONE: ( 2001 ) 936 - 4-/C/Z0 <br /> DATE: /D 4 j <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />