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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/O IACILITY <br /> LOCATED AT <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO N JO UIN COUNTY PUBLIC <br /> e <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION O AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATI <br /> BUSINESS NAME: <br /> (Jj'Applicable <br /> OWNER/OPERATOR: <br /> (Please Prni) (Title) <br /> (Owner/O70 or Signature) (Date) <br /> ADDRESS: <br /> (Maili <br /> 7Address) <br /> iry) (State) (Lip Code) <br /> PHONE: <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />