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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT S . 6 i rfor+ lam,V OC Oorb <br /> rreer Address) 1�1 (Ciry� <br /> HEREBY AUTHORIZE cp/���IyTI L!t r/4w / <br /> i�QW1cl <br /> ( <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 /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: RVe ISR �e.ljl �� <br /> (Please Print) t (Tale) <br /> �� <br /> / ( /Operator Signature) ate) <br /> ADDRESS: In b a5 C 0 YLd D►1 ✓2 - <br /> (Mailing Address) <br /> �o rqn�,P- I 0�A- 90oy_� <br /> (City) u (State) (Zip Code) <br /> PHONE: ( a3) D yy <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />