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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> 2651 SDS �.�p�,_T�1°`.� �oc���.� � CA <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <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 SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESSNAME: � �°�"vS y0\\�,\n <br /> (/fApplicable) <br /> OWNER/O ERATOR: <br /> (� <br /> P/e Pr' (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: ?—G,51l504, <br /> (Mailing Address) <br /> ao�� <br /> (,, (City) (State) (Zip Code) <br /> PHONE:( 2-lock ) �+��, <br /> EH 23 046 (Revised 8/4/06) <br /> 4 <br />