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SAN JOAQUIN COUNTYt' <br />ENVIRONMENTAL HDIVISION <br />0• r <br />" ANALYTICAL RESULTS <br />" GEOTECHNICAL DATA <br />LOCATED AT Z'� o) M/ <br />(Sneer Address) (clay) <br />HEREBY AUTHORIZE c:-a- <br />(Laborarory or n=&ant) <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 />BUSINESS NAME: VIS CA L- � - � 5 8 � �• <br />(If Applicable) <br />OWNER/OPERATOR.' V;-,�'�, (0 I <br />(Please Print) <br />(Owner/Operator Signature) <br />ADDRESS: 2 x 6 0 G SAY-, " F3 ., vd tA l4e,2d to <br />(Mailing Address) <br />(City) (Stare) (Zip Code) <br />PHONE: ( G l i, ) 603 L5– 2" `4 y — <br />DATE. <br />;�– 5 <br />EH 2_3 041 (Revised 7-I0-92) Page 9 <br />