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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 46&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 Z300 `GC LTt T Inn t l <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE l hiTBl�u/-t2au b4L TC�C.11tJ pf 1�L�t Ih6G <br /> (laboratory or Consultant) <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 TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Lr-tL r-45zL <br /> (If Applicable) <br /> OWNER/OPERATOR: G✓ 4f i a ((•I.LG RSskx�IkY !�! 15 L <br /> lease t) (Title) <br /> � j4L6 Sso� <br /> (Owner/Operator Signature) <br /> ADDRESS: to M b0Ld0ji-- 1-;5�uh <br /> (Mailing Address) <br /> fes( I-)LuA�vA GA `Igq'�'A- <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />