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07/24/2006 12:59 464013 ENVIRONMENTAL HEALTH PAGE 07 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZA'T'ION TO RELEASE <br /> *ANALYTTCAL RESULTS <br /> * <br /> OF <br /> OTECFMCAL DATA <br /> EWVIf GXMENCAUSITE ASSESSMENT INFORMATION <br /> I,THE UNDFRSIGNED OWNER AI4DIOR OPERATOP-OF TlIF PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Stmt A s) (city) <br /> HEREBY AUTHORIZE <br /> (Lsb+ar$t1 <br /> TO REL.EASB AAIY AIDE?ALL ANAI,YTICAI.II3FC7RMATI4N Tf7 SAN J A UIN OUNTY ENVIRONMENTAL AL HEALTH <br /> I)EPAI2,TM.ENTAS SOON AS ITIS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MT ENTATIVE. <br /> BUSINESS NAME: _ (Y,'lP'ficable)r£+ <br /> OWNER/OPERATOR: <br /> (Pleme Pt^I►rt) (tette) <br /> pwnarfopamtor.i ) (Dafe) <br /> ADDRESS <br /> (Afaftrng Rridressj <br /> (state) (Np Com) <br /> PRONE:c 7 <br /> EH 23 046 (Revised 1/24/02) <br /> 6 <br />