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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 D / <br /> AUTHORIZATION TO RELEASE <br /> O� 1 <br /> ` ANALYTICAL RESULTS Cytiy 1 I I <br /> ` GEOTECHNICAL DATA J <br /> ENVIRONMENIALSITE ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED OWNER AND/OR OPERA,OR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT IIo P4,5 CrA&jAJ6 2D. 5h5c 61j <br /> (Strew Addre s) (City) <br /> HEREBY AUTHORIZE _ G GOlrf7(�L<kt— '� RtLS N ( _ a-r— c <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: KG 1 .- e e <br /> (Plea a Prim/) <br /> (Ownerl0perator Signature) <br /> ADDRESS: P. 0 V3 D K 5o I <br /> (Mailing Address) <br /> Mo-t>EsTo CA 8535 Z <br /> (City) (State) (Zip Code) <br /> PHONE. ( <br /> DATE: <br /> EH 23 041 (Revised 7-10.92) Page 9 <br />