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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 7 S /Vo /{ur(' &Z ick-roA) <br /> (Street Address) y (city) <br /> HEREBY AUTHORIZE Al c Ntnpn6u_ AIJA U-17-/c.4-L <br /> (Laborato ) <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 /> in— lz <br /> BUSINESS NAME: <br /> (If APpEcable) <br /> WNER/ ERATOR: Vlmc c- 71 <br /> le a Print) �tle) <br /> 3 -1z_v <br /> (Own Operator Signature) (Date) <br /> ADDRESS: © c-< 69/o O o <br /> (Mailing Address) <br /> S"To�Taw7 Q!- <br /> (city) (State) (Mp Code) <br /> PHONE: <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />