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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 qqo w C,L1arkCr way STD�kronl <br /> (Street Address) fCfry) <br /> HEREBY AUTHORIZE C.Am�f m E:1\3\jur0JWlen�a� Tecl7nold�te5 <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN IOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOO AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: F— QUIi-CW E:NTERFR(5>=S LLC- <br /> (If Applicable) <br /> OWNER/OPERATOR: $PI=TT I4OV LAND �ISTRICT Irl InIEER <br /> X <br /> �4 <br /> erator Sig re) (Date) <br /> ADDRESS: �? O gyx SOQSO <br /> (Mailing Address) <br /> MA,2TInl�Z Cf� `14553 <br /> (airy) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />