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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209)468-342.0 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTALISITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) <br />HEREBY AUTHORIZE SFS4 JL,1✓ /,q u <br />('City) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN 30AQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR M <br />REPRESENTATIVE. <br />BUSINESS NAME: I ' � S 7 & F <br />(7fApplicable) <br />OWNER/OPERATOR: ' <br />lease Print) (Title) <br />� G � <br />(Owner/Operator Signature) (Dat <br />ADDRESS. /� <br />(Mailing Address) <br />011 <br />(City) (State) (Zip ode) <br />PHONE: ( i r 3 1,5— <br />EH <br />, <br />EH 23 046 (Revised 3/15/02) Page 9 <br />