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; 1� 11VIRONL HTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone : (209 ) 468 -3420 Fax : (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> i <br /> IF <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AWOR FACILITY LOCATED AT j <br /> 900 S Cherokee Lane Lodi , CA'' <br /> (Sb•eet Address) <br /> HEREBY AUTHORIZE <br /> (Labors P&) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATI � �1 TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE A.XD AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> REPRESENTATIVE. <br /> BUSINESS NAME : <br /> (If App7icable) <br /> OWNER: d / <br /> (Please Print) (Title) <br /> OF (Owner Signaliwe) (Date) <br /> ADDRESS : <br /> IF (1failing Address) <br /> (City) (State) (Zip Code) <br /> PHONE : ( ) <br /> EH230038 (revised 12- 11 - 15) 6 <br />