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..;� 0/18/2005 09:01 209469"3 EHD PAGE 07 <br /> s <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ' ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDFRSIONED OWNER AND/OR OPERATOR OF THE PROP RTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street Address) <br /> (00 <br /> HEREBY AUTHORIZE <br /> (Labor tory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY CNVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILAI)LE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPR1rSENTATI <br /> BUSINESS NAME: <br /> (If Applicbfc) <br /> 0WNMOPERATOR: <br /> (PleasePrink (rifle) <br /> (Owner/Operator S'fgaarure) (Dote) <br /> ADDRESS: <br /> :(R—linraiAddress) <br /> (City) (State) (up Code) <br /> PHONE:(") <br /> EH 23 046 (Revised 1/24/02) <br /> 6 ' <br />