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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 S. -Fr-y-c f,5"324 <br /> (Street Address V (city) <br /> HEREBY AUTHORIZE ev c L46 ~� <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: Rmc -e S <br /> ��(If Applicable) <br /> OWNER/OPERATOR: /�OiP �i`• Y 'y .�ifJ�J�.EJ 'C ���'�'� <br /> ease ) (7-itle) <br /> AR <br /> (Owner/Operator Signatu e) (Date) <br /> ADDRESS: z . / r � <br /> (Mailing Address) <br /> 64 <br /> y <br /> (city) y (State) (Zip Code) <br /> PHONE: ( ) / may' <br /> EH'23 046 (Revised 9/11/96) Page 9 <br />