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ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />Telephone: (209) 468-3420 Fax: (2 09) 468-3433 <br />A=OIRJZATION TO RELEASE <br />ANALYTICAL RESULTS <br />GEOTECHNICAL DATA <br />ENVIRCINMEMAL/SITE ASSESS NIENT INFORMATION <br />1, THE UNDERSIGNED OWNER ANDIOR OPERATOR OF THE PROPERTY ANDIOR FACILITY <br />LOCATED AT <br />(StreetAddress) (City) <br />HEREBY'AUTHORIZE <br />(Leboratmy) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TOS JOA QUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAW <br />TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />(Please Print) (Title) <br />Emu <br />ADDRESS: <br />(Mailing Address) <br />(city) (State) (Zip Code) <br />mug��� <br />P <br />