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0 <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 _ I i 5& N • W i L-SON�►�%�� �T9C-70N <br />(Street Address) f (Cit') <br />HEREBY AUTHORIZE 1 phl % % %�G / ^l <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; MY M I N I KAA,--, <br />(If Applicable) <br />OWNER/OPERATOR <br />ADDRE& <br />(Mailing Address) <br />'r'5 7-01 <br />(City) (State) (Zip Code) <br />PHONE: ( 4--7+-1537, <br />15 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />