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0� <br />SAN JOAQUIN COUNT'S'" <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <br />A.UTHORIZATION TO RELEASE <br />ANALYTICAL. RESULTS <br />* GEOTECTiMCAL DATA <br />ENVIRONMENTAUSTTE ASSESSMENT INFORMATION <br />R, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) <br />(City) <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 />'PRATE IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: <br />ff Applicable) <br />OWNER/OPERA <br />ADDRESS- V <br />� ,rte► -amu», <br />(ZFrle) <br />(Date) <br />l(Ciry) (State) (Zip Code) " <br />PRONE: `i l - � "u S � �,� �J�-?'7 <br />EH 23 046 (Revised 1/24/02) <br />A <br />I <br />` �� r <br />r yr <br />