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0Q/29/2005 15:43 2094643E 5 VALUED ENGINEERING PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)469-3426 <br /> AUTHORIZATION TO RELEASE <br /> ANM-Y77CAL <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,T9F-UNT)FR.-SIGNM OWNER.ANIVOR OPERATOR OF THE PROPEPTY ANDIOR FACILITY <br /> LOCATED ATA <br /> q 5 11 C, <br /> �.- <br /> (Street Aaal-W.T) <br /> HEREBY AUTHORIZE � .( <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THF SAMP. <br /> TIME IT IS PROVIDED To MF OR MY PPPRESr-,NTATFvT-, <br /> BUSINESS NAMF- a Gd G t M�+ q- <br /> (1fApjvtkab1q) <br /> OWNER/OXgWOR: <br /> 6L(o rex-a-.., Jai np-ss vin ef— <br /> (Title) <br /> p <br /> ADDRESS: <br /> (Jailifig-Address) <br /> 6�ac* - q <br /> (City) (51ate) (7;p Code) <br /> .PHONE: 59� —Znc)-2> evll <br /> EH 23 046 (Revised 1/24A)2) <br /> 6 <br />