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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 .2000 -5/ kyY On kaac� -.S�Oc'iAO)I) <br />(Street Address)/� / (City) <br />HEREBY AUTHORIZE 00 Il /"D hVt l Q raTO rc� �e r vi C� s <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: <br />OWNER/OPERATOR: <br />--ScLi ph 4�mq Ayla u noo k-" Fatal1� <br />(If Applicable) <br />6 -uhf Lance - <br />(Please Print) <br />(Title) <br />(Owner/Operator Signature) (Date) <br />ADDRESS: -2000-S-61M40-) )C6001 <br />(Mailing Address) <br />SfaC%L�6w CIq o6-3997 <br />(City) <br />PHONE: (ad 9 > 9S3 - -S� <br />EH 23 046 (Revised 9/11/96) Page 9 <br />(State) (Zip Code) <br />