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11J07/20a2 11:32 269469343? FIFTH FLOOR PAGE: 07 <br />SAN JOAQUTN COUNTY <br />ENVIRO,WENTAL IiEAATH DEPARTMENT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALIMCAL RESU-LI S <br />' GROTECBMCAL DATA <br />ENVIRONMENTAL/SrM ASSESSMENT INFORMATION <br />L THE UNDERSIGNED OWNER ANWOR OPERATOR OF TfM PROPERTY AND/Olt FACTLiTy <br />LOCATED AT G «'l C`4f?01,4 <br />(Street _iddress) <br />fc��) <br />zMRz;DY AUTxOR.rzr; <br />r -P4 . LAPp <br />(Labvraror!) <br />To RELEASE A *"Y AND ALL ANALYTICAL, Ii.'ORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL I3E_AL r H <br />DEPARTMENT AS SOON AS IT IS AVAnA LE AND AT THE SAmZ <br />TIME IT IS PROVIDED TO NJE OR MY REPRESEhTTATI'VT_ <br />BTJSINESS NAML: �- L-s� G j c tt--� <br />(YfApplicable) <br />OWNER10PERATOR: <br />ADDRESS <br />PHONZ; <br />0\r\1 j\,4 (;�-jisias . <br />(please print] <br />EH 23 045 (Revised 1/24/02) <br />(Whiling Address) <br />(City) <br />5 <br />m INtl.114 C�IQ, <br />(lit%) <br />L <br />ZJ' <br />(Daze) <br />(Mate) op Code) <br />11 <br />