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II i <br /> SAN_ J O A g U I N Environmental Health Department <br /> COU NTY— <br /> i <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> i <br /> i <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR <br /> MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER: <br /> (Please Print) (I'Itle) <br /> i <br /> (Owner Signature) (Date) <br /> ADDRESS: j <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> I <br /> i <br /> i <br /> i <br /> 1 <br /> i <br /> 60f6 <br /> I <br />