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SAN JOEQIVTS <br /> IRRONMENTAL HEALTH DIVISION <br /> VICES <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 PROPERTYAND/OR FACILITY C s <br /> CCG.-. l <br /> LOCATED A f l-a I & (City) I Ct o n TPC ' <br /> (Street Aiiitro-1C <br /> O L] L F( <br /> ,�p <br /> HEREBY AUTHORIZE R� FIT �nJ�R6�wten � �I�Jr <br /> C07 /D S (Laboratory)209 13 3 - 0 7 <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: (Title) <br /> A(Please Print) <br /> �0o <br /> xr/Opera r ignatu r (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> ficoa CA- (Z e) 3 <br /> ^G(City) (State) (Zip Code) <br /> PHONE: ( d T� 1 <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />