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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> T <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 FACILLITY/ <br /> LOCATED AT <br /> S� ddress) _ (City) <br /> E <br /> HEREBY AUTHORIZE L L G �J/ �Qp—, <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: C.p <br /> (If Applicable) / <br /> OWNER/OPERATOR: <br /> (Please Print) (Title) <br /> / ' <br /> (OwnkVOperator Signature) / (Date) <br /> ADDRESS: —;) 4463 LA <br /> (Mailing Address) <br /> �- e ria <br /> (City) (State) (Zip Code) <br /> PHONE: ( J J/ ) ; [ `y ���',� <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />