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e/16/2005 09;01 ?' '663433 EHD <br /> ' PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNENT <br /> (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RrSULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/Oft OPERATOR OF THL PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street�4ddrua) (CrrY) <br /> HERESY AU7`HORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL IN ORMATION TO SAN JOAQUIN COUNTY ZNVIRONM.ENTAL <br /> DEPARTMENT AS SOON A IT IS AVAILAI3L$ <br /> N. ND AT THE SAME HGALrH <br /> TIME IT IS PROVIDED TO ME Y REPR15SE ATI <br /> BUSINESS NAME; <br /> ( rcoblc) <br /> O W NER/OPERATOR: <br /> (P e orin� (7iNc) <br /> ADDRESS: (Own /0peralor6,' nature) <br /> (Dare) <br /> (MallinR�ddreSa) <br /> (City) (Stare) rllp Code) <br /> PHONE: <br /> FH 23 046 (Revised 1/14/02) <br /> 6 ' <br />