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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 OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 2-7179 S. E� Omoa <br /> _r <br /> ( /eee� fl/ (city) <br /> HEREBY <br /> HEREBY AUTHORIZEAF� <br /> �ic Ix. /Qclrco <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 /> OWNERIOPERATOR: <br /> (Please ) (Title) <br /> "(Owner/Operator Signature) (Date) <br /> ADDRESS: 32/ / `�x"" " , i ae_xeeo Chi 9Y.SS_' <br /> 7 <br /> (Mailing Address) ' <br /> (City) (State) (Zip Code) <br /> PHONE: 1�5 Z/7� <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />