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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 /> • ENVIRONMENTALJSITE ASSESSMENT INFORMATION <br /> L THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 57-00 S. e)f�-i s MA' 7,0 -Y <br /> (Street Ad ,re�s��) (City) <br /> HEREBY AUTHORIZE ( 906- 1V1) i cA t, <br /> (laboratory or Consu&=) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME T yfE IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE- o <br /> BUSI1\IESS NAME: � i ( �o'0LF ,4hi O WZt 1JT��y C ll i <br /> (If Applicable) <br /> OWNER/OPERATOR: t4KM LAIRD i�R�SID�Nr <br /> (Please Print) (;r ,/f n (Title) <br /> (Owner/Operator Sigpature) <br /> ADDRESS: fzuD S. c1+CtwA,-N <br /> (Mailing Address) <br /> y CA- �s376 <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> DATE: 119 <br /> _ 7 25— <br /> EH ?; 041 (Revised 7-10-92) Page 9 <br />