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..i <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <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 lO©O <br /> (Street A&iress / (City) <br /> HEREBY AUTHORIZE e-- /� D/(IiPG I/// C4 e— C 4 6 QZ/ �/F S <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: <br /> —(I/T Applrc� 2!,2 0 S /G�G�/O�/ <br /> OWNER/OPERATOR: TJ r~zow 0T JAI Z.0 FFLry <br /> (Please Pring irte) <br /> x, If �l-! <br /> /(Owner/Op_er/ator atur, (.Date) <br /> ADDRESS: `T_ oZ � /� ELI-2©�C41-20 <br /> (Mailing Address) <br /> STC/C176�',� <e,�• 9s'a o.?, <br /> (City) ,/ (State) (Zip Code) <br /> PHONE: (2 P `7 t/� '?7_3 �� <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />