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P. � O <br />SAN IOA UIN 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 900 V16 /yP,-- j2Qo+b Q b- <br />(Str et Address) / (City) <br />HEREBY" AUTHORIZE_ graze om 'y -119 -ant 6 <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: <br />OWNER/OPERATOR: <br />1}&eAfi <br />Fol <br />rcc <br />(If Applicable) <br />f <br />ADDRESS: 24ko O <br />(Mailing Address) <br />Si Al �&,�J bto CV1 !7yl <br />(City) (State) (Zip Code) <br />PHONE:S�i®> 61L ^ A14 k-;?f/D2.. <br />H 23 046 (Revised 08/13/99) Page 9 <br />