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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> ' GEOTECHNICAL DATA <br /> " ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILIT/Y� <br /> LOCATED AT q I u 8 road c q StockV1 <br /> HEREBY AUTHORIZE (StreetAddreh)y A1DOCI LQJ0 (City) <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: g N W Ue✓ TrtALK( i - <br /> (I Applicable) <br /> OWNERIOPERATOR: r"lLL <br /> (Please Pri ) (Tirle) <br /> lef <br /> (Owner/Operator Siggnnattur�e,)� (Dare) <br /> [� <br /> ADDRESS: f 1& r• - ' <br /> (Mailing Address) n <br /> e5loeJr/Ztt,' Cf <br /> (City) (State) (Zip Cade) <br /> PHONE: (_Xj) qT/L l z r� to(—If <br /> EH 23 046 (Revised 10119/98) Page 9 <br />