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l ' <br /> t <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ' <br /> ENVIRONMENTAL HEALTH DIVISION ' <br /> (209)`468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> z ANA 3_ <br /> * GEOTECHNICAL DATA , <br /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I <br /> I THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILIT , <br /> 1 <br /> LOCATED AT <br /> (Street Address) (City) <br /> 3 HEREBY AUTHORIZE ' <br /> _ (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> t HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME' <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME V <br /> E (If Applicable <br /> OWNER/OPERATOR r r b <br /> {Pte4nerperator <br /> t) (title) <br /> 3 /2- 11,V <br /> ( Signature) (Dat . <br /> t ADDRESS <br /> (Marling Address) <br /> 0 <br /> {city} (Stare)� �Lrp Code} <br />— - - - PHONE_( <br /> � i <br /> EH 23 046 (Revised 08/13199) Page 9 <br /> r� <br />