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SAJ JOAQUIN COUNTY PUBLIC HEALTH SE*ICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY�J :7 <br /> LOCATED AT ` cm- MO. kmswAx <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE AIpIt0.Nn&L4 A Lebora6 ur_S 1 rnC a.A.c_ K Itifc. Tit, <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 /> BUSINESS NAME: <br /> (If Applicable)) <br /> OWNER/OPERATOR: T10� !'ywL&,'L OWA/WL. <br /> ("ielfn'nt) (li le) 'Z)( (p ) <br /> ADDRESS: 4U57A110. E01SZA1 S7. <br /> (Mailing Address) <br /> (City) C (State) (Zip Code) <br /> PHONE: ( .41-01 ) �J 4-U3(c, <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />