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SAN JOAQUIN 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 S7 `t— 0 G _% L_y 1 c7, Q <br /> (Street Address) e (City) <br /> HEREBY AUTHORIZE 6,1-0iA,,I,AL1/T'1GA �4-0� lL►� 5 A /'1f�Qr�STt) L;A <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: At- <br /> (If Applicable) <br /> OWNER/OPERATOR: -S/qI-At,',4 Al <br /> (Please Print) (Title) <br /> -51a K�� 2 /_2 - <br /> (Owner/OperatorSignature) I (Date) <br /> ADDRESS: 5'7ty4- W <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: 833 3 4f1 6 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />