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SAIMOAQUIN COUNTY PUBLIC HEALTH S'EftVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468.3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHIYICAL DATA <br /> • ENVIRONM&NTAUSITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER ANDiOR OPERATOR OF THE PROPERTY F.'ID/OR FAA�ClLrrY <br /> LOCATED AT +5x08 S 4pZLANJKLx romck ( tfi�(P <br /> (Street Address) (C ty) <br /> HEREBYAUT'HORIZ VEDAV <br /> (Laboratory or Consaitaru) <br /> TO RELEASE ANYAND ALL ANALYTICAL INFORNLATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HR-kL7H SERVICES AS SOON AS 7 IS AVAILABL:. AND AT THE SANM TL�LE IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: M09(£i2 &Curr Ti.4 <br /> ////(IfAPpdcable) <br /> OWNER/OPER-kTOR: NjA( )�UAJroA14.yJ .ro",4� <br /> (P!ease Print) (Tale) <br /> �1 (Owner/Ope'r/ator ign e) <br /> ADDRESS: q-,;Ve 5. �'Agw l . <br /> (Mailing Address) <br /> 64weff 641qp ��zZi <br /> (city) (State) (zip code) <br /> PHONE: ( Ze) <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />