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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� /eft_ w A- <br /> (Street Address) / (City) <br /> HEREBY AUTHORIZE S a o ti -AA . (Ab <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 Applicable) <br /> OWNER/OPERATOR: vvx 2✓` <br /> (Please Prin =::� Z _ <br /> - F-56 <br /> (Owner/ perator Signature) (Date) <br /> ( <br /> ADDRESS: I P o . P p, 103 <br /> (Mailing Address) <br /> COX <br /> (City) (State) (Zip Code) <br /> PHONE: (a& ) — S 3 (O <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />