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09/26/2008 FRI 16: 48 Fax 2094683433 SJC RSD 2005/001 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * <br /> ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 0 <br /> (Sheet Address) (City) <br /> HEREBY AUTHORIZE <br /> (LnGoratmy) <br /> TO RELEASE ANY AND ALL NALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS 1 AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR Y REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (/f Applicable) <br /> OWNER/OPERATOR: <br /> (pleas print) (Title) <br /> (Owne Operator Signatxrre) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> ---- (Ci[y) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 8/3/07) <br /> 4 <br />