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iI <br /> A- <br /> L) -L) <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> 01 <br /> ENVIRONMENTAL HEALTH DMSION <br /> (209)468-3420 <br /> i <br /> AUTHORIZATION TO RELEASE <br /> i <br /> " ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 3R Z e 1rY�p. �S <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE CSD !`� `{ I- <br /> (Laborntory) <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: e .5 <br /> (If Applicable) _ 1 <br /> OWNER/OPERATOR: <br /> (Please Print) irle) <br /> wnerl perator gnancr atel . <br /> ADDRESS: `C"� �ax 70-5 <br /> Address) <br /> e a� ,4- <br /> (City) (State) (Zip Cade) <br /> PHONE: (Q01 35` 7 <br /> EH 23 046 (Revised 10119198) Page 9 <br />