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12-09-1997 09:n-15PI•I FR!-!I'1 TC! P.09 <br /> 0 <br /> t <br /> r � <br /> SAIV JOAQUIN' COUN'T'Y PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 4633-3420 <br /> AUTHORIZATION TO RELEASE <br /> I <br /> i * ANALYTICAL RESULTS <br /> ! <br /> i <br /> * GEOTECHNICAL DATA <br /> I <br /> 9 * ENVIRONMENTAL/SITF, ASSESSMENT INFORMATION <br /> i <br /> I, THE UNDERSIGNTED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> r <br /> LOCAT�D AT �i�d E A _(3* S444 t•)Tr f_ .'es'r oe.r---ro f 1 <br /> (StreetA ress) {City} <br /> HEREI3 AUTHORIZE rr'�) r. <br /> (Laboratory) <br /> TO KkLEASE ANY AND ALL ANALYTIQAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT 15 AVAILABLE AND AT THE SAME <br /> 1 <br /> TIME 1115 PROVIDED TO ME OR MY REPRESENTATIVE. <br /> --llf <br /> 13UISINESS NAME: <br /> (If Applicable) <br /> OWNtRIOPERATOR: <br /> j (Please Print) (Title) <br /> er/operator Signator {Date) <br /> ADDRESS: 1-7 D 1 TAM Q', 5+14,J-,-F-IL <br /> (Mailing Address) <br /> (City) (State) (Lip Code) <br /> P <br /> ) 475 - <br /> � <br /> PHONE: ! �� i � � C� <br /> i <br /> i <br /> EH 23 046 (Revised 9/11/96) Page 9 <br /> i <br />