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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED <br /> pp��OWNER AND//O(OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT JOO1 dJCt7�//� S PGA0 3T 4)CKT,01� <br /> (Street Address) [ _(CrtY <br /> HEREBY AUTHORIZE �I�f C 5 , <br /> 04l <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: PR 1 G L <br /> (If Applicable) n <br /> OWNER/OPERATOR: S Y 1ln 1n E I� <br /> ( le Print (Title) <br /> 30 µ10✓98 <br /> (Owner/Operator Signature) (Dare) <br /> ADDRESS: 1 WSJ © /7 D Q\!!2!jw Rci�o <br /> (Mailing Address) <br /> —STO C KTpn/ 2 n::7 <br /> (City) /(� (State) (Zip Code) <br /> PHONE: ( 7o-7 -2y / 2-37C <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />