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07/30/2.008 WED 15: 27 PAX 2094683433 SJC EHD 0OC6/030 <br /> ENVIRONINAIENTAL HEALTH UEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RLSULi".3 <br /> IGEOTECIINICAL DATA <br /> ENVIRONMENTAL/SI'T'E ASSESSNIENT INFORMATION <br /> J,THE UNDERSIGNED OWNER AND/OR OPERATt R OF THE PROPERTYANID/C-l' FACLITY <br /> LOCATED AT <br /> (Street Address) (cay) <br /> 1,1FIZEBY A-JTH0JWE. <br /> �s <br /> aaharmory) <br /> TO RELEASE ANY AND ALL A14ALYTICAL WrORMAJ10N TO SAN J0AQJ0i.\ COUNTY ENVIRONME"N'I'AL HEALTH <br /> DE',ARTMENTAS SOON, AS IT IS AVAILABLE AND AT711E SAME <br /> TIM',',IT IS 111tOVIDED T('-')ME OR MY REPRE:SENNTATIVE. <br /> BUSINESS NAME: <br /> OWNER;OPERATOR: <br /> --v <br /> (Please Print) <br /> P, (Owner/Operator Signafurv) <br /> (Datc-) <br /> ADDRESS: <br /> (.4failing A dd,es��) <br /> (city) cca'c) <br /> PI)ONE <br /> FII 23 046 (Revised 8/3/07) <br /> 4 <br />