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0 INWO lily" <br />(209) 46 3420 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />* GEOTECHN'ICAL DATA <br />Flyrif I I F� llray"-a* <br />Ve 1111711 1 1 1 1 1 r <br />LOCATED AT <br />SI,e -ess) (city) <br />HEREBY AUTHORIZE <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 />BUSINESS NAME: / t� <br />(lf*p&;,able) <br />OWNERJOPERATOR: <br />i ffl`' "r�� <br />(Date) <br />ADDRESS-_ <br />(A"ling Address) <br />(city) (Stove) (7ip Code) <br />PRONE: it 1-4c-, <br />EH 23 046 (Revised 1/24102) <br />8 <br />