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- - <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> A.UTHORIZA.TION TO RELEASE <br /> =ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> ENVIRONMENTAUSI TE ASSESSMENT INFORMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANWOR FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> ?ARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> 3 <br /> BUSINESS NAME: <br /> (If Rpplicable) <br /> OWNER/OPERATOP, <br /> (Please.Print) (741e) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS- <br /> (MaXngAddress) <br /> (City) (State) (tip Code) <br /> PHONE:( ) <br /> r" <br /> EH 23 046 (Revised 1/24/02) <br /> G <br />