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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNEDOWNERAND/OR OPERATOR OF THE PROPERTY AND/OR FACILITYLOCATED AT J 5 S J08aQuiL COPNITY <br /> (Street Address) (Ci ) <br /> HEREBY AUTHORIZE �,��c c� A u l ci l +',C x` <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC t`' �y <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: SNCL(-, 5EINICES TI <br /> (If Applicable) <br /> O WNER/OPERATOR: 5HUL D 1 L, Co , <br /> QCL <br /> (Please Print) (Title) <br /> u IZ <br /> 1(6vCe <br /> ` Ap'est ignature) a <br /> ADDRESS: 17790 VVILLOW ��S �()(�f) :�Ucm, � 00 <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> DATE: / 94 <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />