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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 C 6 r WA D4.5�`A) C <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE A L_ AL,-A.A LA -T-1 C-A <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; <br /> (If APp icable) <br /> (Please Print) (Title) <br /> (Ow er/Operator Signature) (Dare) <br /> ADDRESS: r�1 q A,t 57-, <br /> (Mailing Address) <br /> (City) (State) (Zip Cade) <br /> PHONE: ( ?__66 ? `/(,,c <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />