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- N . <br />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 �'3 a / <br />(Street Address) / (City) <br />HEREBY AUTHORIZE V�JCSyR7— t f,3 . <br />(Laboratory or Consultant) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: Ooi /C % e &Ar /l -e -s Z'I)G . <br />OWNER/OPERATOR <br />DATE: <br />(If <br />ADDRESS: f, 0 6 b, S R yS <br />(Mailing Address) <br />r &c1nor2% C/� 9yS3 5;L - <br />(City) (state) (Zip Code) <br />PHONE: (,S -/O 6 5 ?- -- S s a a <br />EH 23 041 (Revised 7-10-92) Page 9 <br />