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S)tleJOAQUIN COUNTY PUBLIC HEALTH SE1410ES <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 /> { A IuII <br /> LOCATED AT 3515 2 &(,> swl-ro-4) <br /> eet Address (City) <br /> HEREBY AUTHORIZE �u{7ii{ <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 Applic e)e)� <br /> OWNER/OPERATOR: �Kc ' I� -1 I <br /> (Please Print) le) <br /> Owner/Operat(r Sign re) ( te) <br /> ADDRESS: <br /> r—lailing Address <br /> U \ (State) (Zip Code) <br /> PHONE: ( \� ) U- -2q'Aq <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />