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SAN JOAQUIN 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 AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT ��/4 B (,� {�P-��l�rY,c-� �G�-✓� Ly�c <br /> (Str Addess) (City) <br /> HEREBY AUTHORIZE I t�/iyir1*rM S <br /> (Laboratory or Consultant) <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: C-I <br /> n (If Applicable)) <br /> OWNER/OPERATOR: An(ir L D[7� �� n C f)DG(C� �cmS �ntl��i5NM 6-S . <br /> (Please Print) (Title) <br /> wrier/Operator Signature) <br /> ADDRESS: 5a5 w l <br /> (Mailing Address) <br /> dCtPt-turd <br /> (City) (State) (Zip Code) <br /> PHONE: ( ab�1 ) 593 " L/ 7 <br /> DATE: <br /> z42kmber- alp,l55V <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />