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0 <br /> ENVIRONMENTAL L EAT T <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/O FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMTION TO SAN JOAQUI COUNTY ENV NMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND T THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATI E. <br /> BUSINESS NAME: <br /> (IfApplicab ) <br /> OWNER: <br /> (Please Pri t) (Title) <br /> (Owner Sig ture) (Da <br /> ADDRESS: <br /> (Ma ing Address) <br /> (City) (State) (Zip Code) <br /> PHONE:( ) <br /> EH 23 046 (Revised 02/20/09) <br /> 5 <br />