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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_ ?511 citi C. �y L�C��cc <br /> (St rge lAdl & L 11 y 1 r m tYl e4l ty) e <br /> HEREBY AUTHORIZE �L`° <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: �a G.I G 1 ►i ' I <br /> (If Applliicabl ) <br /> OWNERIOPERATOR: T <br /> (P ease Prin) (Title) <br /> ra s Signature) Aleffiffiamw <br /> 1 <br /> ADDRESS: (o 2_46" Gro o LeJ Lk Lir'c(e. <br /> ! (Mailing Address) <br /> c,k GA qS24 9 <br /> � (City) (State) (Zip Code) <br /> PHONE: J-09 S J" /2-0-7 <br /> t <br /> 9 <br /> EH 23 046 (Revised 08113/99) Page 9 <br />