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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 jgoq� b Al �' ��� <br /> (Street Address <br /> HEREBY AUTHORIZE '�� <br /> (Laborato or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: ,7-�,/ /HzC EJfL "/GF <br /> (If Applicable) <br /> OWNER/OPERATOR: �9G� - <br /> (Please Prin (Tule) <br /> (Owne pera r Signature) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( a--9 ) <br /> DATE: 5--z <br /> — 95- <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />