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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 /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT CfZ:? 10~414-'42 L010/ <br /> freer Address) (city) <br /> HEREBY AUTHORIZE 4yL.49 IIeAC <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 /> (Jf Applicable) <br /> OWNER/OPERATOR: BOB NUrGs DG .v S66GE2 ers0/L <br /> (Please Print) (Title) <br /> /2 <br /> (Owner/Opera! Signature) are <br /> ADDRESS: 97_7 whty <br /> (Mailing Address) <br /> Gobi C*Cmgi ley 9sz�o <br /> (city) (State) (Zip Code) <br /> PHONE: (z_) 393, D 30z- <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />