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09119/'2006 09:16 2094683433 EHD PAGE 05 <br /> 4.NVI i MEN 'AL HEALTH EPA TMENT <br /> S'-AN J'OAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209)465-3433 <br /> ti AUTHORIZATION TO RELEASE <br /> •ANALYTICAL RESULTS <br /> ' GEOTECHNUCAL DATA <br /> " ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE LNOERSIGNED OWNER AND!OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (StreetAddress) (City) <br /> HEREBY AUTHORIZE <br /> — � (Laboratory) <br /> TO ULEASE ANY AND ALL ANALYTICAL EVFORMATION TO SAN JOAQUIN COUNTY ENVIRON MNTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIIVT IT IS PROVIDED TO ME OR MY REPRESENTATIVE, <br /> SUSJNESS NAME: <br /> (V.9pplicable) <br /> OWNEWOPERATOR! <br /> (Please Print) (Titi_7 <br /> (Owner/Operator Signature) ("Date) W— <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zrp Code) <br /> PHONE: <br /> EH 23 046 (Revised 8/4/06) <br /> 4 <br />