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0 if <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGN1E�D OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT (A,)Ah4ifQQ <br /> (Street Address) J (City) <br /> HEREBY AUTHORIZE _SP v urn.0. �Z t _Q�s <br /> (moo ) <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: Flim-v L �� <br /> (If Applicable) <br /> OWNER/OPERATOR: l/ ,/y A A (-h�l1' <br /> (PI, n). (Citle) <br /> 6z �z <br /> J /vner/Operator Signature) (Dat ) <br /> ' 14L; / <br /> ADDRESS: 7 � r,��- �GG�CI <br /> (Mailing Address) <br /> 64- g S,; <br /> (City) �y (State) Zip Code) <br /> PHONE: a86-0 <br /> EH <br /> gs- <br /> EH 23 046 (Revised 10/19/98) Page 9 AN N <br />