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Aug 25 08 09:16a Reliable Petroleum 209-845-8953 p.6 <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 />* ENVIRONMENTALISITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER ANDrOR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street fld&wsa) (City) <br />HEREBY AUTHORIZE <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />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 />OWNERIOPERATOR: <br />ADDRESS: <br />(I_fApplicable) <br />(Please Print) (Title) <br />(Owner/Operator Signature) <br />(Mailing Address) <br />(City) <br />PHONE: ( ) <br />EH 23 046 (Revised 8/3/07) <br />El <br />(Date) <br />(Stale) (Zip Code) <br />