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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <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 1II OPERATOR -(Lb <br /> OFTHE PROPERTY AND/OR FACILITY <br /> LOCATED AT -7717 lln F1rfiylV I 'dfre" 6 M12 <br /> (Street Address) v �. (City) <br /> HEREBY AUTHORIZE &uan jot <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DMSION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: (VQA-kr e`I <br /> (If Applicable) I <br /> OWNER/OPERATOR! �Ic �3�L1, V O 1ANI:SOW <br /> Please Print) Tide) <br /> arm � <br /> (Owner/Ope to Sign mre) Date) <br /> "RoT <br /> ADDRESS: ov y <br /> (Mailing Addr s) <br /> �c <br /> �arf/rmPn� l � 4S1 <br /> (City) 7l J (State) (Zip Cade) <br /> PHONE: ( t <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />