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Jun-09-2010 10:33 AM0+� <br /> PAGE_ 3/ 3 <br /> ENVIRONMENTAL HEALTH 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 /> * k?NVIRONMEN'T'ALAtTE ASSLSSMENT INFORMATION <br /> 1,T14E UNDERSIGNED OWNER ANDIOR OPERATOR OF THF.PROPERTY ANWOR FAC;II.ITY <br /> LOCATED AT <br /> tsir t Address) (City) I <br /> TJFRP,BY AtiTI-101UZ1; <br /> (Lubwrraiory} '--- <br /> TO RELEASE ANY AND ALL ANA,1.YTICAj.INFORMATION To SAN JOAQUIN COUNTY LNVIR[3NMRNTAL HF.AI,TH <br /> DEPARTMENT AS SOON A3 ITIS AVAILABLE AND AT'T'Iig SAME <br /> TIMF TT IS PROVIDED TO ME OR MY REPRESENTATIVE.. <br /> BUSINESS NAME: <br /> (!f.#ppllcuble} I. <br /> o"FR: I <br /> i !I <br /> _. . <br /> (Please Print) (`Title) <br /> (Owser.51oacure) (Date) - <br /> ADDRESS: <br /> (Mailing drum) <br /> PHONE- <br /> FH 23{146 (Revised 02120(1)9} <br /> i <br /> 5 <br /> I <br />