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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 /> * <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILIT <br /> LOCATED AT �D I <br /> (Street Address) {Gary) <br /> HEREBY AUTHORIZE <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 DAME <br /> (If Applicable) <br /> Mr r d f <br /> OWNER/OPERATOR Erle) <br /> (Plecalse Prot) <br /> 3 <br /> t( —ner Aerator Signature) (Dar <br /> ADDRESS <br /> (Mailing Address) <br /> (City) (Stare) (Zip Code) <br /> PHONE ( } <br /> j Page 9 <br /> EH 23 046 (Revised 08113199) <br />