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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 /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT ra '73 .2, W i llcl LUQ o ZO. 5/ 1/e--/clON <br /> (Street Address) S 6 x I nZ_ ,y//Ci�� <br /> HEREBY AUTHORIZE C� /If/f // - <br /> (Laboratory) f <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 Applicable) <br /> Z_ <br /> OWNER/OPERATOR: C `� O ��� 0 <br /> ^7G (PleasePrint) -,(yl (Title) <br /> (Owner/Operator Signature) (Dare) <br /> ADDRESS: ���3 �lr�•2L�/�t�� <br /> (Mailing Address) <br /> (City) (State) (Lip Code) <br /> PHONE: c_,,2�o 9,3 I c 3 S 20 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />