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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> �-�[ , <br /> LOCATED AT 5 l/ C1� l" P/i I l _t 7 CI�w= <br /> (Street Address) A <br /> HEREBY AUTHORIZE i , M ti <br /> (Laborato <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: kr a�( n n t7 (� �1 �yI�C�G1 �7a't go.n . <br /> Q,". <br /> (/f Applicable) <br /> QOWNER/OPERATOR: ,". L to b,I��P ��((i 1 1CQtll t/I tai �NLGt/U2 L'Y <br /> e re ) / (ItNe) <br /> (Own r/Operator Signature) ^ ( <br /> ADDRESS: 4 6 N i I 1 �U1✓h !d <br /> (Mailing Address) <br /> CA aac�a� log C _ <br /> 5 (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />