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SAN JOAQUIN COUNTY PUBLIC I IEALTI-I SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTIIOIZIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />GEOTECHNICAL DATA <br />• ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERA -1-011 01 -THE PROPERTY AND/OR FACILITY <br />AT _-57�� .�� j)1-7QC_ <br />I,— <br />LOCATED - / nc,>z <br />(Street Address) <br />HEREBY AUTHORIZE <br />(Laboratory vl�u-A--...ltanl) " <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME 'TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(1/•. im)uce,we) <br />OWNER)OPERATOR: <br />ture) <br />ADDRESS: &q,7-1 to <br />(Mailing Address) <br />Of <br />(Title) <br />(City) (State) (Zip Code). <br />PI -ZONE: <br />DATE. <br />/�—// <br />,1—` <br />EH 23 041 (Revised 7-10-92) Page 9 <br />