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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 _? (( � <br /> (Street Addr ss (Gary) <br /> HEREBY AUTHORIZE Q(' i(�('► ��/ ���U� �'������ <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SANJOAQUIN 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 /> (1Applicable) <br /> OWNER/OPERATOR: '— �' l71.v�e;�-✓' � ("��)�� <br /> alerint) (Title) <br /> ( wner/Operator nature) (Date) <br /> ADDRESS: J ov cc ?� L\ � <br /> (Mailing Address) <br /> fru,e� -- <br /> (City) (State) (Zip Code) <br /> PHONE: (_�� -) O Jj T 7 3 T <br /> EH 23 046 (Revised 9/11/96) Page 9 <br />