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Sep=12-03 03:09P P_01 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMFNT <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />ANALYTICAL RESULTS <br />GFOTLCHNICAL DATA <br />* ENVIRONMF.NTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />(Laboratory)TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL iIEALTH <br />DEPARTMENT AS SOON AS ITIS AVAILABLE AND AT THE SAME <br />TIME ITIS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME-. <br />(If Applicable) ._. - <br />OWNER/OPERATOR: <br />ADDRESS: <br />PHONE: <br />(Please Print) <br />(Owner/Operator Signature) <br />(Mailing Address) <br />(City) <br />EH 23 046 (Revised 1/24/02) <br />(Title) <br />(Date) <br />(State) (ZIP Code) <br />6 <br />