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>/18/2005 09;01 ; $83433 EHD PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNENT <br /> (209)469.3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RrSULTS <br /> GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Srrcct Addru t) (CrrYJ <br /> HEREBY ALMHORLLE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL IN OKMATION TO SAN JOAQUIN COUNTY L'1JVlRONMGNTAL <br /> DEPARTMENT AS SOON A 1T IS AVAIL,U;� <br /> ND A7 THE SAME HEAL-17H <br /> TIME 17 IS PROVIDED TO ME <br /> Y REPRISE ATI , <br /> BUSINESS NAME: <br /> ( coblc) <br /> O W NZF,/OPERATOR: <br /> (p o Prrn� (7iNe) <br /> (Own /OP�ralorS'l�narir.c) <br /> (Dare) <br /> ADDRESS: <br /> (Mat!!ng AddredJ) <br /> (Crry� (Start) (Clp Code) <br /> PHONE:�� <br /> FH 2-3 046 (Revised ]/24/02) <br /> 6 ' <br />