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SAN�J U A Q U IN Environmental Health Department <br />—COUNTY-- <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL / SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF TBE 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 TIIAE IT IS PROVIDED TO ME OR <br />MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(If Applicable) <br />(Please Print) (Title) <br />(Owner Signature) (Date) <br />ADDRESS: <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />PHONE: <br />6of6 <br />