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1212012606 12:49 2094640138 ENVIRONMENTAL '—ALTH PAGE 89/11 <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 /> ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF T1iE PROPERTY AND/OR FACILITY <br /> LOCATED AT ZS« E, �1taLtj�Tj c�8cb� <br /> (Strutt Addrena) (Ciry) <br /> HEREBY <br /> AUTHORIZE ��" <br /> ��6EcL �A444TicA4i <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> x OWNS ERATOR: F__ S c ti <br /> / (Plca.�r PrtntJ (75'11e) <br /> (Owner/Opersitoorr SYgnarure) Date) <br /> ADDRESS: _ <br /> (Mail inR dddrexr) <br /> �J(City) (State) (Zip Code) <br /> PHONE:(z,0�I 1_ 3 J06 <br /> Eg 23 046 (Revised 11/21/06) 9 <br />