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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DMSION <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 /7ea,�a le <br /> (Street Address) --I /,.I,, (City) <br /> HEREBY AUTHORIZE '1 OY'1'✓(X; LAY/ <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: gWr -Tr-(AM neS <br /> (If Applicable) <br /> OWNER/OPERATOR: /Q1 L !)2- <br /> (Please Print) / (Title) <br /> `,ccr��, <br /> (Owner/Operator Stgre) (Dare) <br /> ADDRESS: J_ `U •ems k <br /> (Mailing Address) <br /> (City) r (State) (Zip Code) <br /> PHONE: ( Z L G� <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />