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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 92 7 6444e- 10~44-4:9 &'p- y 440/ <br /> treet Address) (City) <br /> HEREBY AUTHORIZE G bL.fJ3 /it/C <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION 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: TIFd G tet/ <br /> if Applicable) <br /> OWNERIOPERATOR: BOA "Ilf eeES DAdm427CN $vOE2tiiSo/L <br /> (Please Print) (Title) <br /> fZ 1/D <br /> (Ow'ner/Opera[ Signature) rDarej <br /> ADDRESS: 97_7 81� D/efl>V'y0 Wfjy <br /> (Mailing Address) <br /> LoDl C.,f1-119rz 114 RsZilo <br /> (City) (State) (Zip Cade) <br /> PHONE: ( Z09 393 40,547— <br /> EH <br /> 3d7-- <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />