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05/04/2009 13:17 9163731173 WALTONENGINEERING PAGE 14 <br />ENVIFIRONMENTAL HEALTH DEPARTMENT <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />* ANALYTICAL RESULTS <br />* GEOTECHKICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT wFORMATION <br />1, TI -M UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />ip,,EPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: (rApplicable) <br />OWNER: <br />(Please Print) (Title) <br />(owner Signature) (Date) <br />ADDRESS: <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />PHONE: <br />E14. 23 046 (Revised 02/20/09) <br />5 <br />