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Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br />(Street Address) (City) <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL <br />HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: <br />OWNER: I <br />(If Applicable) <br />N t - -,� <br />(Please Print) <br />(Owner Signature) <br />ADDRESS: <br />(Mailing Address) <br />(Title) <br />(Date) <br />(City) (State) (Zip Code) <br />PHONE: .50c)(,, S-356-3 <br />EH 23 046 (Revised 07/21/10) <br />C. <br />