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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 UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT -7-00 — 07;4/ 42a 1_ t4 z:2M6 <br />(Street Address)_ (City) <br />HEREBY AUTHORIZE �j'f=1/�" kAJ TK C/O / <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(If Applicable) <br />OWNER/OPERATOR: Re eti Zt, 7i <br />(Owner/Operator Signature) <br />r_ <br />0 <br />ADDRESS: J D <br />(Mailing Address) <br />R C t- Zinc' (fl 9_5�96 <br />(City) G / (State) (lap Code) <br />PHONE: (2-02—) /7 `7` fz <br />EH 23 046 (Revised 08/13/99) Page 9 <br />7414? <br />010 <br />