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P. 10 <br /> SAN IOAQUIN COUNTY PUBLIC HEALTH SERVICES <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 AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT - -'9 V l G 7 �Q� j Ob-- <br /> (Strget ddress) (Ci Y) <br /> HEREBY' AUTHORIZE jj (j c�).�} i9 L e L L . <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 /> OWNER/OPERATOR. �/�vG p/g Dmf Q Pr off mr, <br /> 146-eAJ f (Pleas ) (Title) <br /> L—fOwner-/O,Perdfor Signafure) (Date) <br /> ADDRESS: <br /> ()Wailing Address) " <br /> Al CV1 <br /> (Cry) (Stare) (Zip Code) <br /> PHONE: ( (® ) �T/Ci Udo /vL <br /> H 23 046 (Revised 08/13/99) Page 9 <br />