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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />C46� Tech. or ?racrs;on <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAiME TIbIE IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />( :si, „ S YAMEi _ <br />it App&aW <br />El <br />ADDRESS <br />(Slaw) rap Cade% <br />PHONE. (b. -b , U f J !D z <br />EH 23 046 (Revised 10/16/03) Page 9 <br />0 <br />