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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 /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2 7,L9 S !:%L 4,76,P"p •-S l f7GCl 70_42 <br /> i (Street Address) (Cary) <br /> HEREBY AUTHORIZE <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: <br /> (If Applicable) / <br /> OWNER/OPERATOR: ll <br /> �(Please P ) (Title) <br /> — (Owner/OperatorstSignature) (Date) <br /> ADDRESS: 22/ �- <br /> (Mailing Address) <br /> (city) // (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />