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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />(209) 468-3420 <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/OR FACILITY <br />LOCATED AT <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />TO RELEASE ANY AND ALL ANALYTICAL <br />DEPARTMENT AS SOON AS IT IS AVAILAB <br />TIME IT IS PROVIDED TO ME OR MY REPR <br />BUSINESS NAME: <br />OWNER/OPERATOR: <br />AAT <br />A V <br />of <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />(Please Print) (Title) <br />(Owner/Operator Signature) (Date) <br />ADDRESS: <br />(Mailing Address) <br />(City) <br />19061m <br />EH 23 046 (Revised 1/24/02) <br />(State) (Zip Code) <br />0 <br />