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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 J� V Nr <br /> / Street Addre s) / . / / (City) <br /> HEREBY AUTHORIZE C -a e)97fGi /S T/ cam/ <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: CjC� 1i-rct; S <br /> (If Applicable) <br /> OWNER/OPERATOR: RfZ �61,40uk _7-VC :rAfC 41114 <br /> (Please Print) (Title) <br /> � 2 <br /> (Owner/Operator S,ig/nature)) ( te) <br /> ADDRESS: g 4j 1 jVA 1/ W DZ <br /> (Mailing Address <br /> ro ckTOnf CA • ���� <br /> (City) p / (State) (Zip Code) <br /> PHONE: ( .� ) —1 J� S 6( Z <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />