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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 530 L N,�c Lr()_t� y <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE (4 \�\ � <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: 1" n <br /> (If Applicable) <br /> OWNER/OPERATOR: c-) > I:� L\F k L1111 A mY <br /> (Please Print) (Title) <br /> ��/ p —t.Q v �wzy� � <br /> (Owner/Operator nature) (Date) <br /> ADDRESS: AAV C `1 UCCA A LVA ZUCfl <br /> (Mailing Address) <br /> RANC\�(l LC)f4 � w LA <br /> (city) (State) (Zip Cade) <br /> PHONE: ( <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />