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• <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT MFFFO FE/ <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THEPROP Y AND/OR FACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> /REPSENTATIVE. <br /> ratory) <br /> TO RELEASE ANY AND ALL AATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS ITT THE SAME <br /> TIME IT IS PROVIDED TO ME <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> Please Print) <br /> L (Title) <br /> (Owner/Operator Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> PHO/( (City) (State) (Zip Code) <br /> � <br /> EH 23 046 (Revised 8/3/07) <br /> 4 <br />