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ENVICNMENTAL HEALTF, 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 />ENVIRONMFINTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERA OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 1 7 <br />(Streel.4 <br />HCRE13Y AUTHORIZE <br />TO RELEASE ANY AND ALL ANALYTICAULINFORMATION TO SAN JOAQUIN COUNTY ENVIRONMFNTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br />BUSINESS NAME; <br />OWNER: <br />(Please Print) - (title) <br />(Owner <br />ADDRESS; <br />(City) <br />PHONE: <br />EH 23 046 (Revisod 02/20/og) <br />(Zip Code) <br />