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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 46&3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENv[RoNMENTALSITF ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER'AND/OR OPERATOR <br /> �.,O`FTHE PROPERTY AA'D/OR FACILITY <br /> LOCATED AT 3 I Cel ' " TiG C V <br /> (Saes Bess) (C+0') <br /> HEREBY AUTHORIZE Pacz �v I ra✓ C�ra u���n c <br /> (Laboratory or Cor=kant) <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: UV1Or'!5'j C 'o (- O ( b <br /> (If Applicable) I <br /> OWNER/OPERATOR: �Cf l,Jam C ST0() Sr. FnV• 66,01. <br /> lease Print) (7tt <br /> 1 bA6,vJ+' ()Ao <br /> (Own for Signature) \\ -- <br /> ADDRESS: 2000 Cr,,-, aV�VD� u 7C �aU <br /> (Mailing Andress) <br /> Sctyl 2Am a rr\ <br /> (city) (State) (Zip Code) <br /> PHONE: ( SID ) <br /> DATE: 9Ilblgb <br /> EH 23 041 (Revised 7-10-92) Page 9 <br /> NodA WVLE` 1L 9661—S0—L <br /> 8 d <br /> 2025 Gateway Place, Suite 440, San Jose,California 95110 (408) 441-7500 FAX(408) 441-75 i9 <br />