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11/23/15 11:52AM BZ Service Station Maintenance 916-572-1050 P.07 <br /> t'rLq'VIR'Ovm&'Ll"mlmv&IENTI'%AL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> J� <br /> r <br /> i <br /> Telephone; (209)468-:3420 Fax: (209)1468-3433 <br /> EIVEL) <br /> AUTHORIZATION TO RFI,FASE / <br /> NOV 2 3 2015 <br /> °"ANALYTICAL I2F:SUL'I'S /' ENVIRONMENTAL <br /> fn <br /> i I-IFAITW nuoAoTAacAr- <br /> *GEOTECHNICAL DATA <br /> r; <br /> ENVIRONMENTAIJSITF�t ASSESSMENT IN <br /> I,'flit UNI)f'R.sIGNI';I)t)WN?It ANI)/(3R 0KRATOR OF'I'III PRO*R'I'Y ANDtilt FACILITY LQC"A'TFI)Al' <br /> HEREBY AUPORIZE <br /> r <br /> �., ..._........ <br /> TO RELEASE ANY AND ALT.ANALYTICAL INFOI1 `TION'i"O SAN J0At�I.,IIN COUNTY F;NVIRONMENTAL H ALTi-I <br /> I?I I�AR I'MF.NT AS SOON AS IT IS AVAILAF3 ANC)ATTHE SAME'I'CMIr IT IS PROVIDEDT()ME OR M <br /> EPRFSENTATIVE, <br /> 1:3USINF;SS NAME: <br /> j' t�liCtd(>lfi�J ,.w.�,..._.-,....... �.,.._...�...�.,.,___�,.u.,,..._..�,,..,.,_.._._.•.w.__.�._.___ ..,.® <br /> OWNER: <br /> ._._�....,..� .,..__.,,(Please!'riot) <br /> (Owner SYgmature) <br /> ADDRESS: <br /> ftWi• avw+--..•—•..v..�,..w..i.u.u�._.......,w�.,�_..�.....,..,.....--..V�,yen_..•_•_N.�u...e.._.._..,,�..w.__...»._.....wx..�--�—v <br /> (Slt7te) (lip Ctjtle) <br /> PHONL <br /> EI-123046 (Revised 07/2//10) <br /> 6 <br />