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0 152 <br /> SAN J()AQ11IN('(H pNI-Y PI)BLIC HEALIIi SERVICES <br /> ENvIRo,%ME%TAL HEALTH DIVISION <br /> (-109)461(-3;20 <br /> AIrIH()RIZATION TO RELEASE <br /> Tank 836—DIU1 <br /> *ANALYTICAL RESULTS <br /> "GEOTECHNICAL DATA <br /> •ENVIRON'MENTAUSrM ASSESSMENT INFORMATION <br /> I.THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Canal hokw R ', <br /> a�{Street Address) Win) <br /> HEREBY AUTHORIZE a CALIFORNIA LABORA $1' SF'RCrr( � <br /> (L,ahoraton•or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC HEALTH <br /> SERVICES AS SOON AS rr IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME: I awmier Li N ^^l t ahor mry <br /> (If Applicable) <br /> OWNER/OPERATOR: Ce.i t•erlenn (htner <br /> (Please P Rtr �(TuC ✓ <br /> (Owner/Operator-Signature-)- <br /> ADDRESS: Z()()() * Ave. 0 Box 909 <br /> (Moiling Addres.0 <br /> LivCant-wre- re 94141 <br /> (Cin) (State) (Zip Code) <br /> PHONE: (4M) .423-677 <br /> DATE: <br /> EH 23 041 (Revised 7/10192) <br /> 9 <br />