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• ! <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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORM ON <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPER /OR FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Cabo or <br /> TO RELEASE ANY AND ALL ANALYTICAL INFO TION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE ND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REP SENTATIVE. <br /> BUSINESS NAME: <br /> (IfApplicable) <br /> Applicable) <br /> OWNER/OPERATOR: <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS- <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE:( ) <br /> EH 23 046 (Revised 8/3/07) <br /> 4 <br />