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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 /> men$for <br /> I, THE UNDERSIGNEDIZER OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT-4&27 Pa Vine-i Prive, <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE _West LGI; � tOZies <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: JouWand amore 2.04052- <br /> Agent-br (If Applicable) <br /> OWNER/ n Lr2gp l C_-21"an(ne <br /> (Please Priv) (ritle) <br /> '$ Ifo q$ <br /> e�7U" <br /> Operator Signature) (Date) <br /> ADDRESS: &50 Howe Ayenu5 + <br /> (Mailing Address) �{ <br /> SaC..rsrnelnto CA I 0?-5 <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />