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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 10 East 12th Street, Trac-- C'a1 i fnrnia <br /> (Street Address) (City)- <br /> HEREBYAUTHORIZE McCampbell AnalY tical 0 110 2nrl Galif-o-r-nia <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: Pacific Bell <br /> (If Applicable) <br /> OWNER/OPERATOR: Pacific Bel l-JoSep{a Q-rt[_-Prof ect Manager <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: .1(o00 C 14rU q4q Ra W"Qt 4 t Roots 3E000K <br /> (Mailing Address) <br /> sa+� k400�- <br /> (City) (State) (Zip Code) <br /> PHONE: ( 8'T7 ) 8 Z3 - 9 833 <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />