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. SAN J'OAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO _RELEASE <br /> ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER ANDY/OR OPERATOR OF THE PROPERTY AND/OR FACrIILLIT <br /> LOCATED AT <br /> (Street Address) � r (City) <br /> HEREBY AUTHORIZE X51 9 r <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: PA� k <br /> (If Applicable) J <br /> OWNER/OPERATOR: U <br /> (Please Pint) V (Title <br /> (Owe Operator Signature) ( te) <br /> -ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( ) <br /> EH 23 046 (Revised 08113/99) Page 9 <br />