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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />' ANALYTICAL RESULTS <br />• GEOTECHNICAL DATA <br />• ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT �4il L:�43 7- M li 11? `JMelf7T 8, f:?)i\) <br />(Street Address) (City) <br />HEREBY AUTHORIZE FFOGAc LUc T' �Zoc , <br />(Laboratory or Consultant) <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 />TO ME OR MY REPRESENTATIVE <br />BUSINESS NAME.�Nc Z i� `—�� s iC et P 7TON <br />(If App&abk) <br />OWNER/OPERATOR: <br />DATE: <br />(Mailing Address) <br />C)1 cX) 1� L A- qV Z o <br />(City) (State) (Zip Code) <br />PHONE: (5—I O ) <br />EH 23 041 (Revised 7-10-92) Page 9 <br />