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Dict 09 OG 09:56a R R E*neering <br />81884237 <br />p.7 <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 />" ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 470 l <br />(Street <br />HEREBY <br />AYr nPT� <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 SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />O)ATNER/OPERATOR: <br />ADDRESS: <br />(Mailing <br />(City) o � las <br />(Zip Code) <br />�l <br />PHONE: (5 5 8 'las I . <br />EH 23 046 (Revised 8/9/06) <br />C <br />7 <br />