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Mar 28 08 10:03a Sandra Barnhart 2098458586 p.7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209)468-3420 Fax: (209)46&3433 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF TIAL PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street Address) {Cihy <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JO,AQUIN COUNTY EN'V'IRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS N AME: <br /> (If Applicable) <br /> OWN E WOPERATOR: <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: _ <br /> (NMailirng Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 8.x3107) <br /> 4 <br />