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:0,JOAQUIN COUNTY PUBLIC HEAL# -RVICES <br /> /_Ml ENVIRONMENTAL HEALTH DIVISiA4 <br /> (209) 46&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 L <br /> ( <br /> HEREBY AUTHORIZE_ (City) <br /> / <br /> StretjAdbrsr) l c_ G (L�Jc' ��_G <br /> (labauroq or ConsvUaw) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> plicable) <br /> OWNER/OPERATOR <br /> (Please P1�nt) �OJu ) <br /> ADDRESS: <br /> (Malting Addresr) Q <br /> (A') (State) (Zip Cade) <br /> PHONE: ( C) 3 q <br /> DATE: <br /> EH 23 041 (Revised 7.10.92) Page 12 <br />