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Sh- &QUIN COUNTY PUBLIC HEALTH zJOCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> *ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 741 Ta (ti 4 e b 1 <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Corral Hollow Road,Ingy,California <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE Calihomda Laboratory Services <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE- <br /> BUSINESS NAME: LawTence Liverrwre National Laboraj= <br /> (If Applicable) <br /> OWNER/OPERATOR: f.Susi j@d=,Omafor <br /> (Please Print) TTitle) <br /> r YqAi�� <br /> (Owner/Operator Signature) <br /> ADDRESS: 7000 Egg Ave.,PZ Box 806 <br /> (Mailing Address) <br /> Lj <br /> �errroreCA 94550 <br /> (City) (State) (Zip Code) <br /> PHONE: (510)423-6577 <br /> DATE:. <br /> EH 23 041 (Revised 7/10/92) <br /> 9 <br /> F31 L� <br />