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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 />ENVIRONMENTAIJSITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 4 `J C -)c-) E. FIZEAl1 t� LI T <br />HEREBY AUTHORIZE (Street Address <br />(Laboratory or Com <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: <br />OWNER/OPERATOR: <br />Applicable) <br />(Please <br />ADDRESS: LI-SCXJ G. <br />(Mailing Address) <br />STOCKTOn( <br />PHONE:( 2 -CC) <br />DATE: - <br />S7 - -/ 2 - f3 <br />ATE:S7-/a-93 <br />EH 731X1 (Revised 7-10-92) <br />(Title) <br />Signature) <br />F- eCMCN i <br />CA <br />(state) <br />C48 - 8U/ % <br />Page 9 <br />G5215 <br />(Zip Code) <br />