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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 ANMD/OR OPERATOR OF THE PROPERTY AND/OR FACILITY �p <br /> LOCATED AT `RST F-Aerm to [J'T reef, '/i CKTo A) C// <br /> (Street Address) pR ec i s i o n c �'ry)4 <br /> HEREBY AUTHORIZE nviR1} �— i cC- <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: J`'n )211� 6:6S(-'/;17e' <br /> (If Applicable) r /y� <br /> OWNER/OPERATOR: EPQQS I f WADI N� Ar-O T,/ O WOEn <br /> (Please Print). (7irle) <br /> (Owner/Operator Signaru�1 /1 (Date) <br /> ADDRESS: ZS�6 `�l�fgsaN1 Pero C)Rc h. <br /> (Mailing Address) <br /> 57Qc-KTon) 952A"7 <br /> (City) (Stare) (Zip Code) <br /> PHONE: ( -L09 ) yly OL/3y <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />