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i <br /> / SAN JOAQUIN COUNTY PUBLIC HEALTH SER vICES <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�A/NSD/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Z`U71 <br /> _ �`�� <br /> (Street Address (City) <br /> HEREBY AUTHORIZE /'�A�/ <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 /> OWNERIOPERATOR: <br /> (Ple e n.nt (title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: U�� �_R <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( ;zo <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />