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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 /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPEERTTYDA�ND/OR FACILITY <br /> LOCATED AT <br /> (Sneer Address) k (City) <br /> HEREBY AUTHORIZE tA CU�Qc'{�_ <br /> I (Lnlmrnsnry) <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 ANDA f I-HE SAME.•, <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS ,LAME: K` X\Cam n"^ C,;.A!a <br /> ��/A� (ifApplicable) <br /> OWNER/ PERATOR: tA?,, �A,NilA©0E (5 WIyE.(r— <br /> xL <br /> 01 <br /> 1 (Trle) <br /> (OwnerlOpent rgnmrtre)) ` .' /� (Date) <br /> ADDRESS: cEk6yay_r W&4 <br /> (Mailing Address) <br /> c�'CT�hI CJS <br /> �,rr��(City) (State) Zip Code) <br /> PHONE: (�SLJ_) <br /> EH 23046 i Revised 10/19/98) Page 9 <br />