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Lon <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 />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT SS / � 57 65CA s J <br />(Street Address) (City) <br />HEREBY AUTHORIZE 6-�v !o_>&Wj7-je_4L_- <br />TO RELEASE ANY AND ALL ANALYTICAL <br />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: <br />OWNER/OPERATOR: <br />(If Applicable) <br />�t Ctt6W L MWLL67ji <br />1qw&)k_ <br />ADDRESS: S S I j, ,'-� <br />(Mailing Address) <br />�c rK j g 6-3Z0 <br />(city) <br />PHONE:( 72-iJ� ) 93P- ?o <br />EH 23 046 (Revised 10/19/98) Page 9 <br />(Zip Code) <br />