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SANOJ AQUIN COUNTY PUBLIC HEALTH SERVICES1�L{� j <br />ENVIRONMENTAL HEALTH DIVISION ff jj11 1_I <br />(209) 468-3420 N O V 1 9 1993 <br />AUTHORIZATION TO RELEASE ENVIRONMENTAL HEALTH <br />• ANALYTICAL RESULTS <br />• GEOTECHNICAL DATA <br />• ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />HEREBY AUTHORIZE �t'ILy ✓©C G 5 (�0211y- (�hde✓ Ni lb��� <br />(Laboratory or Consultant) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />(If Applicable) <br />OWNER/OPERATOR: <br />(Please Print) (Title) <br />(Owner/Operator Signature) <br />ADDRESS: <br />(Mailing Address) <br />(City) (State) (Zip Code) <br />PHONE: ( ) <br />DATE: <br />EH 23 041 (Revised 7-10-92) Page 9 <br />