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SAN , JOAQUINP <br /> Environmental eaith Department <br /> _._ C 0 U N T Y._..._ <br /> AUG 2'' 22017 <br /> AUTHORIZATION TO RE EASE <br /> ENVVION" ..^.L H-ALTH <br /> D :_NT <br /> * ANALYTICAL RESULT <br /> *GEOTECHNICAL DA A <br /> * ENVT NMENTAL/STTE ASSESSMEN INFORMATT N <br /> I,THE UNDE SIGNED OW ER AND/OR OPERATOR OF TH PROPERTY AN /OR FACILITY OCATED A <br /> ,I <br /> (Street A rens) (Ci �) <br /> HEREBY AUT ORTZE <br /> (Laborat ry) <br /> TO RELEASE NY AND ALL AN LYTICAL INFORMA ON TO SAN OAQUIN CO TY ENVIRONM NTAL <br /> HEALTH DEP RTMENT AS SOO AS IT IS AVAILABL AND AT TH SAME TIME IS PROVIDED T ME OR <br /> MY REPRE NTATIVE. <br /> BUSIN S NAME: <br /> (IfApplica le) <br /> OWNER: <br /> tlease Print) (Title) <br /> wner Sign tore) (Date) <br /> ADDRES <br /> Mailing Ad cess) <br /> (City) (State) (Zip Code) <br /> PH NE: <br /> 6of6 <br />