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11!16%88 1723 <br /> • N0. 108 005 <br /> 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 /> • ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 40XS� r, Ncl I �rdC O1 <br /> (Strew Address) (C tyl <br /> HEREBY AUTHORIZE <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 15 AVAJIABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESEN'T'ATIVE. <br /> BUSINESS NAME: a a r (�ff f V + C�e— <br /> (if AppiXaUk) <br /> OWNPR/OPERATOR: a L <br /> tin <br /> (Please Priv) M*) <br /> /OPemu" Signature) e1 <br /> ADDRESS: $ M <br /> (Kailing Address) <br /> � a 4 3215 <br /> 0 <br /> (city) (State) (jp Code) <br /> PHONE: ( f ) b z " 8 a '7 <br /> EH 23 046 (Revised 9/11/96) Fage 9 <br />