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�iON � °, .t ' � � �O, Ij 6 nvirom-nentai Ilealth ttvpartment <br /> V <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 LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> Ep�' V^ ?1A / G� 6 t& Ot/ <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br /> SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE . <br /> BUSINESS NAME : v�l ///� Ak © C l;4flfl � / l /p <br /> (If Applicable) 1p1te�F4 �Ya <br /> OWNER/OPERATOR: /� <br /> (Please Print) (Title) <br /> (Owner/OperanEz <br /> ore) (Date) <br /> Of <br /> ADDRESS : 8 L ��- <br /> (Mail ing Addr <br /> (City) ^� O (State) (Zip Code) <br /> PHONE : ( �� l t 7 <br />