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<br /> <br /> <br />8 of 10 <br /> <br />Environmental Health Department <br />AUTHORIZATION TO RELEASE <br /> <br /> * ANALYTICAL RESULTS <br /> <br /> * GEOTECHNICAL DATA <br /> <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />____________________________________________________________________________________________________ <br /> <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br /> <br />____________________________________________________________________________________________ <br /> (Street Address) (City) <br /> <br />HEREBY AUTHORIZE <br /> <br />____________________________________________________________________________________________ <br /> (Laboratory) <br /> <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE <br />SAME TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> <br /> <br /> <br /> BUSINESS NAME: ______________________________________________________________________________ <br />(If Applicable) <br /> <br /> OWNER/OPERATOR: ______________________________________________________________________________ <br /> (Please Print) (Title) <br /> <br /> <br />______________________________________________________________________________ <br /> (Owner/Operator Signature) (Date) <br /> <br /> ADDRESS: ______________________________________________________________________________ <br />(Mailing Address) <br /> <br /> ____________________________________________________________________________ <br /> (City) (State) (Zip Code) <br /> <br /> PHONE: (_________)___________________________________________________________________ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />