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ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone. (209) 468-3420 Fax. (209) 468-3433 <br />AUTHORIZATION T 0 RELEASE <br />ANALYTICAL, f�ESULTS <br />GEOTECHNICAL DATA <br />ENVIRONMENTAL/SITE ASSESSMENT INM11MATiON <br />I, THE UNDERSIGNED OWNER AND/01Z OPERATOR OF THE MOPMY AND/OR FACILITY <br />LOCATFDAT_44/2-6 C- KOA Lnp -I- <br />(Stre", Address) (city) <br />HFIZEBY <br />AUTHOR <br />TO kELFASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH I)EPARTMENT AS SOON AS IT IS AVAILABLE AND AT'IME SAME <br />TIME ITIS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(If App lic a b le) <br />OWN ER/OPERATOR: <br />ease <br />ADDRESS - <br />(Title) <br />(Dat <br />(Mulling Address) <br />-6e - 5 <br />(City) (state) (Zip Code) <br />PHONE: <br />EH23046 (Revised 12/31f07) 9 <br />