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01/19/2006 14:06 4840138 ENVIRONMENTAL HEALTH PAGE 07 <br /> SAN JOA QUINT C0 TY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468.3420 <br /> AUTHORIZATION TO RELEASE <br /> ANALYTICAL RESULTS <br /> GEOTECHNITCAL,DATA <br /> ENVIRONMIENTAL41TE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER ANDIOR OPERATOR OF THE PROPERTY /OR FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> aborafory) <br /> TO RELEASE ANY AND ALL ANALN'TICAL MORMATION TO SAN JOAQUIN CotJWry ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAW <br /> TIME IT is PRO viDED'TO mE OR MY REPRESENTATIVE. <br /> BUSINESS NAME: (If Applicable) <br /> OWNLERIOPERATOR: <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: (Matting Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 1/24102) <br />