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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> °ANALY-TICAL RESULTS <br /> 'GEOTECHNICAL DATA <br /> ro ENVIRONMENTAL/SITEASSESSMENTINFORMATION <br /> I,THE UNDERSI ONED OWNER AND/OR OPERATOR Of THE PROPERTY AND/OR FACILITY � <br /> LOCATED AT O&LI (-I40W , F I S!IAC c�-MMA�( ' <br /> {Street Andress) (City) <br /> HEREBY AUTHCRIZE <br /> �f2C—CiSi�N C�1Jilk�-i�:Ctf 31��c� �.�G�.S� sIIjP <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORUMATION TO SAN JOAQUIN COUNTY ENViRONMNNTAL HEALTH <br /> DEPARTMENT i AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT I$PROVIDED TO M6 OP.MY <br /> REPRESENTATIVE. <br /> BUSWZSS NAME: a3 l�Cf�lV �� CC1V� C1� <br /> VApplicable) <br /> OWNER/OPEP.ATOF: I P^£`N'J- �iNOI�iI�LE� c,—amu :fi_ rvid a� 9i� ' <br /> (Please Print) (Title) <br /> 4 R 2z 0 <br /> (Owner/Operator Sio'nature) (Date) JJ <br /> ADDRESS: 63�`f 1-41VPJI Cert <br /> (2vwliag Address) <br /> 5'ilt,C�4VN C A <br /> p (City)p (. aie) (Zip Code) <br /> EH 23 016 (Ruvistd 10116/03) Pape 9 <br />