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04-21-93 11:39AM <br /> (Set Cn+eY Cegtaf Ttewti `( � <br /> SAN]OAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (2M 468.3420 <br /> AUTHORIzATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> OEOTBCHNICAL DATA <br /> • HNVIRONMENTALAITE ASSESSMENT INFORMATION <br /> 4 THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT (SdcerAddrrsrJ {ay') <br /> HEREBY AUTHORIZE <br /> {LaberaJarJ'a Canssdant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (IfApplkobh) <br /> OWNER/OPERATOR: <br /> (Owner/OpertiWr Sipature) <br /> ADDRESS: <br /> (MaXng Addnera) <br /> (00) (State) (Zip Code) <br /> PHONE: <br /> DATE: <br /> EH 23 041 (Revised 7.10.42) Page 9 <br />