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�RECEIVEL a 1 s 5 <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 UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �5(0 9% �)- G ���"�'�.�n �V <br /> (Street Addr s) (City) <br /> HEREBY AUTHORIZE Cnzcl '""I, 4�' 's � <br /> (L460tnrarY) <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: �S�• M0.CU � SC�Od <br /> (Il Appli ) C / <br /> *OWNERIOPERATOR: �£✓ • .IO At y/ / 4 C LOA✓ tqf i i t�t ✓ <br /> (Pie=*Print) (title) <br /> J'- O• -7'ea;e� 4�40411 <br /> et/Operator Signature) (Date) <br /> ADDRESS: 9• p. Ecu 2 Q LI'7 <br /> (Mailing Address) <br /> S cSF.�ova Cg,_ 45Q(0- CDY7 <br /> (City) (state) (Zlp Code) <br /> PHONE: <br /> EH 23 046 (Revised 9/11/96) Page 9 <br /> Z0 39dd -1d1N3WNDNIAN3 1HDINM ZSIGZ6860ZI 9b:60 8661/6Z/80 <br />