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SAN JOAQUIN COUNTY PUBLIC 14RA:.TH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> 12091468.3420 <br /> AUTHORIZATION TO RELEASE <br /> »ANALYTICAL RESULTS <br /> " GECTECHNICAL DATA <br /> » ENIVIROYMENTAL/$ITE ASSESSIMENT RMORMATION <br /> I, THE UNPERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANDIOR FACILITY <br /> LOCATED AT �g 5 6� S-c <br /> !Street Addmis, (clh') <br /> HEREBY AUTHORIZE GeoAna ytical Laboratories <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYT?CAL 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 A4E OR MY REPRESENTATIVE. <br /> BUSINESS NAME:` <br /> (If Applicable) <br /> OWNERIOPERATOR: Joe Omachi <br /> !phase Pint) merle) <br /> Oyys,c....G � G c 1'� a2.G , cl <br /> weer/Operator Signature) (Dau) <br /> ADDRESS: <br /> 1.�3ai:urg Address) <br /> e�� (cit) (Stat:) (71p Cade) <br /> PHONE: ( �1 7 7 —'�' a — <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />