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16:30 2094 33 FIFTH FLOOR I& PAGE 13 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209)468-3420 <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 <br />(Street Address) - (City) <br />HEREBY AUTHORIZE yry <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SARI JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: Oc" 9-a r7 lk nT- YQk"j w <br />(YApplicable) <br />ADDRESS: <br />(Mailing Address) <br />-s4 o CAI-� <!A . ltd(. <br />(City) (State) (Zip Code) <br />PHONE: ( Z09 elu - ozz-9 <br />EH 23 046 (Rrvised 1124/02) <br />C <br />