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JAN 05 '95 1.O."3r, P.H.L. PETFLU1 x1 <br />. ,•'� . OAQUIN GOUh"IY PUlit.)C HEALTH SE-010ES <br />ENVIRONMENTAL. HEALTI3 DIV)S)ON <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />• ANALYTICAL RESUIr7'8 <br />• OF-07BCI-WICAL DATA• <br />r ti-'L,OXWENTAL/SrM ASSFSSh, F -N7 INFORMATION <br />F, 7XB UNDERSIGNED O'W7,�&R ,AND/OR OPERATOR OF 7HE PROPERTY AND/OR FACILrly <br />LOCATED AT <br />(S.^Ya.9aQress) , (City) <br />HEREBY A(T'i iORI7E I t +N�t�ti�-l.. Lrj'f�'f i <br />(1-4oralory or Cansu&w) <br />TO RELEASE ANY AND ALL ANxL.YTXAL INFORMA71ON 7,0 SAN 1OAQUIN COUNTY PUnLIC <br />NFAI .STN c 3? virga A C cnn%7 L C rr TQ A VA IT APT T3 A k4n d'C"T`IJC S A i RII "r"A/[�7 T'P tC pfl /l[/TT1�tt <br />TO ME OR MY REPRESENTA77V7- <br />BUSNESS NAhM, SIG ALL �. <br />(If-4pplkable) <br />OM4ZRIOPFMAMP4 IS T V -C- Ltl-1 <br />AnDRFSS: <br />DAM � <br />C r� �• <br />W.M <br />G <br />{�a�tfng�tcl�ssx) . <br />(City) (stare) (T,fp Code) <br />P -H 23 041 (i c&zd 7.10.992) Pag0 9 1 <br />