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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />f (209) 468-3420 <br />1:mjrAfAVm =119MIMINWAIM, <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 />LOCATEDAT IQi�(� E.1�5-( IkkZgj_7C)o lUC. -TON LN 2�5 <br />(Street Address) (City) <br />HEREBY AUTHORIZE <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: SNM — UQ ""Q \ n1 <br />(If Applicable) <br />OWNER/OPERATOR: <br />(Owner/Operator <br />lAb7 K V-100 L C 1011 <br />(Title) <br />(Date) <br />ADDRESS: Sp.\U 'S0 ,ou\ N COON 7 L )AUZ):C\ <br />(Mailing Address) <br />I 1(-) C P*-, 1,2 Jt� LL^I 0 1& 5. �ocy `CUR\ r)-, �) S, U C) <br />(City) (State) (Zip Code) <br />PHONE: (ate) l -i & f' - 3 O 2 2 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />