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ENVIRONMENTAL L EPA T T <br />SAN JOAUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIR MENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OkOPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br />(Street Address)(City) <br />HEREB UTHORIZE <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION N SAN JOAQUIN COUNTY ENVIRONMENTAL <br />HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT NE SAME TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: \ <br />(If Applicable) <br />OWNER: <br />ADDRESS: <br />PHONE: ( ) <br />EH 23 046 (Revised 07/21/10) <br />(Please Print) (Title) <br />(Owner Signature) \ (Date) <br />(Mailing Address) <br />(City) (State) (Zip <br />i <br />