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SAN JOAQUIN COUNTY / <br />E*goNVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />I F,,. HEALTH <br />,;rR;riCF <br />AUTHORIZATION TO RELEASE 03 DEC 12 PM 4: 56 <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 <br />LOCATED AT <br />ir.r <br />(Street Address) <br />HEREBY AUTHORIZE <br /><2-xlt,Cotr <br />5� <br />(City) <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 TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />ov <br />(Please Print) <br />(Owner/Operator Signature) (Date) <br />ADDRESS: FI -j <br />(Mailing <br />(City) <br />PHONE:( 209 <br />EH 23 046 (Revised 3/]5/02) Page 9 <br />(State) (Zip <br />