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f8(THU) 14: 19 CITY 0R"-4CY TEL:209 8; X30 <br /> P. 004 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVLU014 <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 /> WCATEID AT <br /> (,� _5rreer res.�1 <br /> HEREBY AUTHORIEfCrty)Z ` L � <br /> oracoryJ - <br /> TO RELEASE ANY A,ND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-EINVI,RONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT I5 PROVIDED TO ME OR MY RF-PRFSENTATIVE, <br /> BUSINESS NAME: <br /> (if FlicableJ e- L. C,�'�R <br /> OWNER/OPERAT <br /> lease PnnrJ. <br /> (Owner/Operator Signdturr) <br /> ate) <br /> ADDRESS. ' <br /> fMailin f Addra r) <br /> Ilk <br /> fGlrYl fStarrJ (Zip Code/ <br /> PHONE: { ) CZ 7=1 <br /> EH Z3 046 (Revised 9111196) <br /> Page 4 <br /> b9 �J'Cd �ti.�N3WNQCIt1N� !�-;JI�v('1 <br /> ZST5ZE960i;1 g��LO 866T/S0/B0 <br />