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01/25/2002 10:09 2094683433 FIFTH FLOOR PAGE 07 <br /> 04) <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <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 <br /> 7 W 6-49ANJ-1 WIVE f2oAQ -1-9 AC <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> r AWALrlc L - �F-L1c,r 5R z)) 2�7- boa <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL.HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> 5A 'JLS2.N Se"tcFc CAMPS-�� <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: 1 <br /> (4ii5�9-LLX- Lf-AfJ ; 10C, Afitr� e1-SW-A-) <br /> (Please Print) (Title) <br /> /r (�Owoer/Operator gnat re) (Date) <br /> ADDRESS: _ �W 7 15z ezA coclEr , 7-61117—&- \--( <br /> (Mailing Address) <br /> ,n vii /,-I <br /> C� (City) (State) (Zip Code) <br /> PHONE:(!Z ) 5 5 1 ZS-5-S— <br /> EH <br /> SSS— <br /> EH 23 046 (Revised 1/24/02) Page 6 <br /> 6 <br /> JAN 25 ' 02 9 : 13 2054683433 PAGE . 007 <br />