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• <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 O yWNNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILIT <br /> I <br /> LOCATED AT j/DR I 1 I��N9���� p � M, <br /> HEREBY AUTHORIZE (Street Address) (City) <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 /> BUSINESSNAME: Uelwffn��q "T M-c1:1 <br /> (If Applicable <br /> OWNER/OPERATOR: 7alSb< <br /> (Ple e Pr t) <br /> itle) <br /> 3 <br /> ( ner Per <br /> Signature) (Data) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( ) <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />