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0 0 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMA <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/ R FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMAT N 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 REPRESS T <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />C' t <br />(If Applicable) <br />(Title) <br />(Owner/Operator Signature) (Date) <br />EH 23 046 (Revised 1/24/02) <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />D <br />