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NOV-12-98 04 :46 Pit PAC I Y- L: <br /> 11/1298 THL' 10:28 F:LA 2094e 18 <br /> :1GL•-S1'OCXTUI' 0602 <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> "ANALYTICAL RESULTS <br /> •GEOTECHNICAL DATA <br /> " ENviRONMENTALISITE ASSESSMENT INFORMATION <br /> 1.THE UNDERSIGNED OWNER AND/OR OPERATOR OF THEPROPERTY AND/OR FACILITY <br /> LOCATED AT _ 4Yc6 �R c Fit gqye_ ST. c nro nl _ <br /> HERESY AUTHOWZE �'t <br /> (Street Address) A j eT t JA L.(ciry) `@ <br /> C <br /> ,j PiC- <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL,HEALTH DIVISION AS SOON AS IT 1S AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> .(if plicabre)// <br /> OWNEwOPERATOR; {� G� <br /> mile) <br /> (Oe•®cr/Op wt w signmure) (Dme) - <br /> ADDRESS: INCA,, 7-hCip<— <br /> (Moiling Address) <br /> cS GKT®rJ c _ 4.0or2 <br /> Wiry) (Syme) (Tip Code) <br /> PHONE: X77 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />