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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 12 y W �'�•� S�rc�-t Lo�.i <br /> Street�rens) ` (City) <br /> HEREBY AUTHORIZE M C�,,r.bLG( A,,.1'. � I <br /> ( atory) <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 1T IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: ?mc t P.C �t <br /> (If Applicable) <br /> OWNER/OPERATOR: Sol.-x t tc�� Senior �Kv�c'or.wL e,.�aL f�a✓trti��� <br /> (Please Prins) (Title) <br /> weer/Operator Signature) ate) <br /> ADDRESS: Z(000 L'aw�t" 2C,w.ok% 1Zw. 3EO00T <br /> (Mailing Address) ,�pp <br /> 'sati. �" q q5$3 <br /> (City) a (State) (Zip Code) <br /> PHONE: <br /> EH 23 046 (Rcvised 08/13/99) Page 9 <br />