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SA-14 JOAQUIN COUNTY PUBLIC HEALTH SERVI <br /> E:�tiZROrtifENTAL HE-LT:: DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> ,.NALY i iCAL RESULTS <br /> GEOTECHNICAL DATA <br /> * ENVIROMMENTA.USI E ASSESSNCENT INFORMATION <br /> I, T-HE UNDERSIGNED OWNER avD/OR OPERATOR OF Tr_= ?ROPERiY AND/OR FACL 1 f <br /> LOCATED AT 700 E:- Y---I7'"/— <br /> (Scree:Address) <br /> HEREBY AU iIHOR ZE 4/027'V T EA%25 <br /> (LaLoratory) <br /> TO RELE.=.SG ANY A.�D '- I- AN�I-Y T C.�L I`+:OR.tit_�.TION TO SAN JOAQUIN COUN `! PLBLIC <br /> H=ALT'r_ SERVICES-ENVIRONvfE'+TAL HF--\ T'r. DIVISION AS SOON AS i IS A.VAILA-BLE :-ND AT i.:E S11tii= <br /> TItifE IT IS PROVIDED TO ME OR %vfY RE�2ESE.`+iAiVE. <br /> BUSI,iESS NAME: p2�e��� /,S�li �e,Po/ Sa,irJ ortav//J <br /> (If Applicable) <br /> OWNS-R/OPERATOR: ZG le-17c c, /cc.�i�'h:c./! G/?�e>G lnsfa,�l'�.ron S✓A TSeer'iiocS <br /> (Please Print) (Tale) <br /> (Owne-/Operator Si narure) (Dare) <br /> ADDRESS: /0, O BoX 9604x/ S 7`-oc<1//7'of , Gfl. 9-S29G <br /> (Mailing Addr=s) <br /> �r7) (Scare) (Zp Cade) <br /> ( <br /> PHONE: ( 209 ) 9s92 - 3a�a <br /> __: 33 046 (Revised 9/11/96) Pate 9 <br />