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ENVIRONMENTAL <br />COUNTYSAN JOAQUIN <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY 7 FACILITY <br />LOCATED AT <br />(Street Address) <br />HEREBY AUTHORIZE <br />TO RELEASE ANY AND ALL ANALYTICAL INFRMATIO O SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE A AT SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTA <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />(Please <br />� , • <br />110 <br />EH 23 046 (Revised 8/3/07) <br />(If Applicable) <br />yfnt) (Title) <br />Operator Signature) (Date) <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />4 <br />