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h <br /> G <br /> 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 <br /> AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 1R0f 5, 61 6VgaA? 9vt4� <br /> ,(Street Addrgs) Ip / (City) <br /> C[. <br /> HEREBY AUTHORIZE LO�U(AI/lU/i}T( (4 l Ab <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: <br /> (If AppJl�icable-) - <br /> OWNER/OPERATOR: 7e (7 u l t4/V <br /> (PI asePrint) (Title) <br /> u 2 <br /> pp(O pferlO/peratJor Signature) (Date) <br /> ADDRESS : 7� p �tel <br /> (Mailing Address) <br /> Mcm e 5c) (A gs 7 <br /> (City) JJ rr (State) (Lip Code) <br /> PHONE: <br /> EH 23 046 (Revised 10/ 19/98) Page 9 <br />