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OCT-07-2003 TUE 11;00 AM G TLER RYAN FAX N0. 70 893218 P. 08 <br /> e.. 6vvc ao:n7 day4Ei PIFTH FLC PAGE 07 <br /> SAN JOAQUIN COUNTX <br /> EN'V IRONMENTA.L HEALTH DEPARTMENT <br /> (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> "ANALY'1'IC.A,L PE.Sum <br /> GEOTECHNiCAL DATA <br /> ' BNVIRONI4N'I'AWITE ASSESSMENT 1NFORIvL4TIQN <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF TIE PROPERTY ANI)/OR FACILrrY <br /> LOCATED AT <br /> (StYeea Address) (Lyry) <br /> REEY ALTMORTZE <br /> GK44boraxory) <br /> TO R ANY AND ALL ANALYTICAL DrPORMAMN To SAN JOAQUIN COUNTY ENvrRON,,4'ENTA TH <br /> DEPARTMENT AS SOON AS IT 1S AVkTLABLF,AND AT THE g <br /> AME <br /> TIME IT IS PROVIDED TO ME QR MY kEPRES ATTVE. <br /> BUSINESS NAME?: <br /> (ff ApplfcableJ <br /> OWNER/OPERATOR; <br /> (Please Print) tT�rle) <br /> (Dwoer/Operator Signature) (Dare1 <br /> ADDRESS; <br /> (R?m7ing Address) <br /> (City) (State) (ZfP Code) <br /> PHONE- <br /> .H 23 046 (Revised 1/24102) Page 6 <br /> 6 <br /> JAN 25 '02 9: 13 209468343 3 PAGE, 007 <br />