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11/26/01 17:12 FAX <br />� v <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />' ANALYTICAL RESULTS <br />s GEOTECHNICAL DATA <br />. ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street <br />HEREBY AUTHORIZE <br />(City) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />M, <br />HEALTH SERVICES -ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME <br />FAm <br />OWNER/OPERATOR: L <br />(Plense Pri (Title) <br />ADDRESS, <br />er/Opera or Sig Lure) (Date) <br />tiling Address) nn p <br />'rvl f (State) (Lip Code) <br />PHONE:( aC ? ) s 3 1- LA 00 <br />EH 23 046 (Revised 08113/99) Page 9 <br />