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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JN COUNTY <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 /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTYAND/ R/FACILITY <br /> LOCATED AT 7 <br /> (Street Address) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> y <br /> Laborator <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMAT TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESEN TIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (Pleate Print) (Title) <br /> Z?fOwner/Operator Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (city) (State) (Zip Code) <br /> PHONE: <br /> EH 23;06 (Revised 8/3/07) <br /> 4 <br />