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SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (W9) 468.3470 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ENVIRONMENTAL/STTE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR <br /> OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT_ \4aNCtd i F J:L Z0ZrtC?p <br /> (Strad A#dws) p (City) <br /> HEREBY AUTHORIZE�}SSS C.i Wrt il,_. LQ Rn2A�o n t st <br /> (Labprw1w7 w�4a+wr) <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 /> (I/ abk) <br /> O WNER)OPERATOR: t)d k n r-(4�y (iso Jt- <br /> (Ple Print) (Title) <br /> ( er/Op Al ODr �urj ) J <br /> ADDRESS: �) A E/ cy0 ✓ddc) �t) <br /> (Mailing Address) <br /> CA ITS G-L <br /> (C*) (Srate) (Zip Code) <br /> PHONE: ZU' 2 <br /> DATE: 2 ' y �G) 9 <br /> EH 23 041 (Revised 7-10.92) Page 9 <br /> T7TaL P.03 <br />