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SA?nOAQUIN COUNTY PUBLIC HEALTH SEIc4ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468.3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNERAND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT /,)/�S N'' ))P Of; PCI <br /> jo dc_ <br /> HEREBY AUTHORIZE a-b (C <br /> ity) <br /> �ureAC <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: U,, T^c- <br /> (1fAPpUc ) <br /> OWNER/OPERATOR: /9Z6err-- 72 96Aj <br /> (Please Print) (Title) <br /> (Owner/Opera orig ture) (Date) <br /> ADDRESS: /9,5_P/ E �OrIPT/C2 �O <br /> (Mailing Address) <br /> Cam CA <br /> (city) (State) (Zip Code) <br /> PHONE: 2,69q ) <br /> EH 23 046 (Revised 08/13)99) Page 9 <br />