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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �/ ` CE <br /> (Street. Bess) (City) <br /> HEREBYAUTHORIZE Pac v ranyhe aQ C�raug Z'vt c. <br /> (Jdroratory or Consa/tant) <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 REPRESENTA'TI1VE. <br /> V <br /> BUSINESS NAME: yl d ro-,j r oO (-r b ,(\ <br /> (If Amileahie) I <br /> OWNER/OPERATOR: ECf/Warj G �140n Sr. Env. 6fd <br /> lease Print) (Titjy— I, <br /> (Own for Signature) II <br /> ADDRESS: 2000 C ML j C&V\\/O,/\ P IGtLQ , u; goo <br /> (Mailing Address) <br /> S(�tvl 2avvlo.-\ CA �iys�3 <br /> (City) (State) (Zip code) <br /> PHONE: ( S 0 ) 2-4q - 2,3� <br /> DATE: gl I b I ,;I / <br /> EH 23 041 (Revised 7-10-92) Page 9 <br /> 8 -d WOtid WViE° ll 9661—SO—L <br />