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0 0 <br /> ENVIRONMENTAL HEALTHT <br /> SAN JOAUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> * ENVIRONMENTAL/SITE ASSESSMENT INF RMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE OPERTY AND/OR FACILITY LOCATED AT <br /> (Street Address) (City) <br /> HERE Y 7THORIZE <br /> (Cabo <br /> rat ) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT AS SOON AS IT IS AVAILABXE AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br /> PRESENTATIVE. <br /> BUSINESS NAME: <br /> ( Applicable) <br /> OWNER: <br /> (Please Print) (Title) <br /> (Owner Signature) (Date) <br /> ADDRESS: <br /> (Mailing Address) <br /> (City) (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Revised 7/21/1(0) <br /> 6 <br />