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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 ANDIOR FACILITY <br /> LOCATED AT <br /> (Strget^dCreT� ye f aA 'AIry) <br /> HEREBY AUTHORIZE <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 /> 1 , <br /> BUSINESS NAME: �Q G I L w ® i 1fit <br /> f (IfApplliLicabl ) <br /> OWN R/OPERATOR: if T Lon d " "' <br /> (P ease Prin) (Title) <br /> ! WONNOWA&Signature) <br /> � <br /> ADDRESS: <br /> (o Z(oGro o k e� chi c.k ir'�e_ <br /> ' (Mailing Address) <br /> CAI -7 (City) (State) (Zip Code) <br /> PHONE: ( L4� I ) 't S ," I 0-7 <br /> i <br /> t <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />