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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTALDIVISION <br />(2 09) 3420 <br />AUTHORIZATION TO LEASE <br />: ANALYTICAL RESULTS <br />° GEOTECHNICAL DATA <br />* <br />ENVIRONMENTAI.41SITE ASSESSMENTINFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR • •.. OF PROPERTY AND/OR FACILITY <br />(StreetAddress) <br />HEREBYAUTHORIZE 6-+ f j <br />r r r r r r <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATIONTO SAN JOAQUINCOUNTY <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br />TO ME OR REPRESENTATIVE. <br />« t y • &: <br />Applicablef <br />(City) (State) (Zip Cade) <br />PHONE: <br />DATE: <br />EH 23 041 (Revised 7.10-92) Pane <br />