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r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUINCOUNTY <br /> Telephone: (209)468-3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATIO <br /> L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY:/AN R FACILITY <br /> XPII <br /> LOCATED AT " <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ALL ANALYTICAL O TI TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENTAS SOON AS IT IS AVAILABLE A SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENT TIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (Ple a Print) (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH, 046 (Revised 8/4/06) <br /> 4 <br />