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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 369 L . fI to 571 / /9 C y <br /> (Street Add ) J ' (City) <br /> HEREBY AUTHORIZE� � �[� A065 <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: CITY O y Tf—A CY <br /> (If Applicable) <br /> OWNER/OPERATOR: /3/ti �� O%6�� <br /> (Please Print (Title) <br /> (Owner/O r Sig e) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> fey U" 15,370 <br /> n (City) (State) (Zip Code) <br /> PHONE: (JO 431- 11KY <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />