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E <br />T <br />ENVIRONMENTALTH <br />1 <br />SAN JOAQUIN COU <br />Telephone: (209) 468-3420 Fax: ( 9) 468-3433 <br />AUTHORIZATION TO RELEASE <br />* ANALYTICAL SULTS <br />* GEOTECHNI AL DATA <br />* ENVIRONMENTAL/SITE ASS SSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF �HE PROPERTY AND/OR FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE A / //�j <br />TO RELEASE ANY AND ALL ANALYTICAL INF'ORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />5 <br />