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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 g.35 CA (Sirg��17 kho/ h (� <br /> HEREBY AUTHORIZE //�Q� ' <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: aiy �� �/ qo/ <br /> IfA (�CI'/t-Y.l Applicable) J /1, (' <br /> OWNERIOPERATOR: MAUI) AA<�jp-. C. 0� 1 <br /> �t/�•� �(Please Pnn (ritle) C < <br /> (��nU O�w��ner//O,pera or Signature) (Date) <br /> ADDRESS: � l Cl, 13/mol. <br /> (Marling Address) <br /> Troy �A- 9537/0 <br /> (City) (stare) (Zip Code) <br /> PHONE: ( xq ��I-yUDd <br /> EH 23 046 (Revised 08/13/99) Page 9 <br /> I� <br /> 1 <br />