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1112610.1 17:12 FAx <br /> Z02 <br /> s i'. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTALHEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> y 'r <br /> *ANALYTICAL RESULTS <br /> " GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> i <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY , <br /> LOCATED AT ! <br /> (Street Address) t i= (City) <br /> HEREBY AUTHORIZE G — Al <br /> i (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />' HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> i <br /> BUSINESS NAME: <br /> (If APpli" le) ''r <br /> ell <br /> OWNER/OPERATOR: � (Title) <br /> (Please Pri t } <br /> (Owner/Opera or Sig are) (Date) <br /> ADDRESS: 3 <br /> (Mailing Address) <br /> IG ` (State) (tip Cde) <br /> Ir (city) <br /> PHONE: ( — a <br /> EH 23 046 (Revised 08/13/99) Page 9 <br /> i <br />