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L � <br /> 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 OPERATOR OF THE PROPERTY AND/OR FACILITY \ /^ <br /> LOCATED AT Z—] rR L� ®/� STS ��T gTo'^�DN C <br /> (Street Address) _ t I (City) <br /> HEREBY AUTHORIZE PKCL I $lobi Lw12.0 <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: CLArV ) �Ctl°t �'LOWS� <br /> 0+ (i� <br /> (If Appl cable) 'fl�� pp�� <br /> 1/wm <br /> OWNERIOPERATOR: TLcV _Ep DI>\1N <br /> (Flease'Pri�nt)� � �jmile) <br /> (Owner/Operator Signature)— (Date) <br /> ADDRESS: _312-1 rpM(7/V� e)1 S Tr —otfT- <br /> (Mailing Address) <br /> STpc _iw CA 9 sZ o 5 <br /> r7 (City) (State) (Lip Code) <br /> PHONE: ( Lc)l ) q+3 — 2-m ± <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />