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14.� ..i <br /> 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 UNDERSIGNEDD�'O��WNER AND/OR OPERATOR OF QT-HE PROPERTY AND/OR FACILITY <br /> � -z �j <br /> LOCATED AT y sEaL_ Y( -0 q,f=� <br /> (Street Address) , <br /> HEREBY AUTHORIZE ZP.�/ln <br /> (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: K �l <br /> (pleas (Ttle) <br /> Owner/Operator Signature) (Date) <br /> ADDRESS: ,Py <br /> (Mailing Address) <br /> nn;6) Jad�Q,+ <br /> (City) (State) (Zip Code) <br /> PHONE: 6 <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />