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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 OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT �')-1 Q( Ur,k —�'Cbc <br /> (� (Street Addris (City) <br /> HEREBY AUTHORIZE U� <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: 0 Z) . MW <br /> (1 plicable) <br /> OWNER/OPERATOR: !SA-p ` Q, U I Q l� — 7�ve� ✓- �� �3) �n <br /> (Ple aPrint) (Title) <br /> Ap_tL- S 07b_aq :z <br /> 2( er/Operator *nature) (Date)v <br /> ADDRESS: 500 co TC?� �` l �A <br /> (Mailing Address) <br /> (City) q [ / 2 (State) (Zip Code) <br /> Y,5 <br /> / <br /> PHONE: ( , S31 T ,5J / - <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />