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SAN IOAQUIN COUNTY PUBLIC HEALTH SERVICES R F—r F I V E D <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 AUG 2 6 1997 <br /> ENVIRONMENTAL HEALTH <br /> AUTHORIZATION TO RELEASE PERMIT / SERVICES <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL, DATA <br /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PRF�OPE TY AND/OR FACILITY <br /> LOCATED AT 5aalzr f' <br /> ( neer( � (Qry) <br /> HEREBY AUTHORIZE r 5� &1 �Gj � / <br /> � <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 /> TEME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: C./ � 4�— 45%z `^' ` <br /> (if.iaoiicable) �^� //,, <br /> OWNEPUOPERkTOR. `wome �en 4,,st e�— <br /> (P.!etue nt) <br /> 8/& <br /> (Title) v <br /> O Zb <br /> er/ tator Signature) (D e) <br /> ADDRESS: <br /> (Mailing Address) <br /> A)Ram- <br /> (City) Q (Stare) (Lp Code) <br /> PHONE: (�J /3�- �7p/%� <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />