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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 2.'S- j i-1, N L`j 1'_, 0 <br />(Street Address) (City) <br />HEREBY AUTHORIZE <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: -70 S L ()r /N C\ u 7� �, I i 1 <br />(If Applicable) <br />OWNER/OPERATOR: I \°1 �� N Vr D K <br />(Please Print) (7-itle) <br />(Owner/Operator <br />ADDRESS: <br />(Mailing Address) <br />C, P\ � 5:) I2 <br />(City) (State) (Mp Code) <br />' � 1►•1�A��ii7�Ti <br />EH 23 046 (Revised 9/11/96) Page 9 <br />