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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 /> ENVIRONMENTALSITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Sy 1 Lai K EZ Z Lt N N(J L (aN C L1:>L \ <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE t <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: A� Q,(7 p.M — 7-�M <br /> (If Applicable) <br /> OWNER/OPERATOR: AR 7- n y Q , ()yam` S C u \\A P R m y <br /> (Please Print) (71de) <br /> (Owner/Operator S nature) (Date) <br /> ADDRESS: �fN17 , <br /> (Mailing Address) <br /> RP.N 7- \A0 0Rh&WA LA A S-14' - <br /> (City) / (Smte) (Zip Code) <br /> PHONE: ( q -7 <br /> EH 23 046 (Revised 10)19/98) Page 9 <br />