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49 =5 <br /> SAN ?�AQUIN COUNTY PUBLIC HEALTH <br /> S ER v <br /> ENVIRONMENTAL HEALTH DIV <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 1191 — (airy) <br /> freer Add ess) � <br /> HEREBY AUTHORIZE , (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC T THE SAME <br /> HEALTH SERVICES-ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND A <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> LZ' <br /> (If Applicable) l <br /> OWNER/OPERATOR: �2�: V' (Ti h) <br /> Please Print g <br /> (Owner/Operator Signal re) <br /> (Date) <br /> ADDRESS: <br /> �u G <br /> ailing Address) <br /> �, <br /> (City) (State) (Zip Code) <br /> ( <br /> 1_ <br /> PHONE: ( aO'' ) 2L <br /> EH 23 046 (Revised 7/10/96) Page 9 <br />