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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (2D9) 46&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 3507 STEVENSON AVENUE <br /> Stree ;ddr (C' <br /> HEREBY AUTHORIZE FALCONt tNERGY/GEOLOGICAL AUDIT/SPARGER TECHNOLOGY) <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ,ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER'OPERATOR: WILLIAM VALENCIA PROPERTY OWNER <br /> (PleasePrint (Tule) <br /> -rte <br /> (Owner/Operator Signature) <br /> ADDRESS: 912 S FAl IF(IRNIA CTRFFT <br /> (Mailing Address) <br /> STOCKTON, CALIFORNIA 95206 <br /> (Cuy) (State) (Zip Code) <br /> PHONE: 2( O9 948 9003 <br /> DATE: �,,% j'— <br /> c.. _ til iRe•.iseti 10-92) Page 9 <br />