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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * <br /> ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT <br /> (Street Address) (Citi) <br /> HEREBY AUTHORIZE <br /> (Laboratory) _ <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (IfApplic•ahle) —- <br /> OWNER/OPERATOR: <br /> (Pleave Print) (Title) <br /> (Owner/Operator Signature) (Date) - <br /> ADDRESS: <br /> (Alailitii>Addrevs) - <br /> (Citi) (State) (lip Code) <br /> PHONE: <br /> EH 23 046 (Revised 1/24/02) <br /> 6 <br />