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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 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE AA4 <br /> a <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 /> 7 <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) ' <br /> ;, T�i4✓E Linc.� <br /> OWNER/OPERATOR: ZArmosw-,r- <br /> (Please Print) (Title) <br /> i <br /> 1 L—I g S- <br /> (Owner/Operator Signature) (Dote) <br /> 1 <br /> ADDRESS: 7r-4V6;7— <br /> (Mailing <br /> 4✓FsT(Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: ( �`I p36 Z/t� <br /> I <br /> EH 23 046 (Revised 10/19/98) Page 9 <br /> is <br />