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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2101 V✓- Lr <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory or nsultant) <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 ZME OR MY REPRESENTATIVE. <br /> `✓ BUSINESS NAME: Vr-i�CA L cP <br /> (if Applicable) <br /> OWNERIOPERATOR: 1V l o + (Oil Co <br /> (Please Print) (Tu e) <br /> (Owner/Operator Signature) <br /> ADDRESS: 2 86<3 <br /> S ,n s� F3 1 rd y 5 20 to <br /> (Mailing Address) <br /> �� �. ,t�b Co2�v✓a CQ �G-10"10 <br /> (Cuy) (State) (Zip Code) <br /> PHONE: ( R I to ) 603 5— 2 y y <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />