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e. SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 1-100 e.'(0y IT F1 Ni'� <br />(Street Address) (City) <br />HEREBY AUTHORIZE QUO1,& AtJA,yY 1 t-- <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: 01'404:: L— <br />(If Applicable) <br />OWNER U 1Gj �1"T i Cap Hl. t'7 IUo o U , We . <br />(Please Print) Mule) <br />ADDRESS: ? �3'1 0 W i LLO _W Fo • 9 t �}' <br />(Mailing Address) <br />4-g.;, <br />(City) (State) (Zip Code) - <br />EH 23 046 (Revised 9/11/96) Page 9 <br />