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EN-WR ON ENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNT' <br /> Telephone: ('1 465-3420 . Fam: (2 09)468-3433 <br /> -ALTfHo=ATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> 'k GEOTECHNICAL DATA <br /> * E r,,,raONN.IENTAL/SITEASSESSIVIENTINFORD,.IAnON <br /> I,THE U/NDDERSIGILITY <br /> NED OjVNER AND/OR OPERATOR OF THE PROPERTI'AND/OR FAC <br /> LOCATED AT -S 5 o IAbolQ 1 C DPJ <br /> (fit f�yl <br /> (Street Address) ( ty) <br /> CAL TECH ENVIRONMENTAL LABORATORIES (PARAMOUNT, CA) <br /> AITTEiORIZE <br /> T- <br /> {�l1�0271#.Of�1 <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO .SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE.SAME <br /> TIME IT IS PROVIDED TO ME OR MY P.EPRESENTATI` 7E. <br /> BIT SINES S N.A 1E: f ac" `1 i C VeAm kLk m 71-1 C- <br /> (lfApplicable) <br /> OWNER%OPERA.TOR: QT <br /> (_ ase Print) ) C <br /> I <br /> lure) n (Date) <br /> ADDRESS: - <br /> (Mailing Address) <br /> (C*ytjy) j (State) (Zip Code) <br /> PHONE:(-3 ) ��- �C� <br />