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11/16/90 17:23 • • NQ. 109 CW05 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (109) +6g-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTALISTTE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT LK '�S ir Na i N --rocAc-T 1 <br /> (Srreel Address) (Cay) <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 IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (UApptitable) <br /> OWNERIOPERATOR: ay 111L k� <br /> (Pfeale Print) �k3 <br /> /Operator signarwe) of <br /> ADDRESS: <br /> (Mailing Address) <br /> (Ciry)V <br /> (scare) fl+p Code! <br /> PHONE: (� b Z <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />