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//18/2005 09:01 2 ;83433 EHD PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL, HEALTH DEPARTMENT <br /> (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALMCAL RrSULTS <br /> ' GEOTECHNICAL DATA <br /> ' ENVIRONMENTAL/SITE ASSESSMENT INrORMATION <br /> 1.THE UNDERSIGNED OWNER AND/OR OPERATOR OF THLT PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street Addrstt) (CiryJ <br /> HEREBY A VI`HORI.ZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL IN ORMATION TO SAN JOAQUIN COUNTY L'NVIRONMGNTAL <br /> DEPARTMENT AS SOON A IT IS AVAILML,E ND AT THE SAME <br /> . � HL•ALiH <br /> TIME 1T IS PROVIDED TO ME Y REFUSE ATI <br /> BUSINESS NAME; <br /> ( cable) <br /> O W NZR/OPERATOR: <br /> (P e orin� (7iNoJ <br /> (Owb Mg <br /> w..) (Dalt) <br /> ADDRESS: <br /> (Malling,Iddr m) <br /> (City) (Stale) ($lp Code) <br /> PHONE; , <br /> FH 23 046 (Revised 1/24/02) <br /> 6 ' <br />