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Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />(Street Address) (City) <br />fffflR• • a <br />(Cabo <br />ratory) <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 TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: <br />(IJApplicable) <br />OWNER: <br />(Please Print) (Title) <br />�`Ti77�1 <br />EH 23 046 (Revised 07/21110) <br />(Owner Signature) (Date) <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />6 <br />