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v 04 2011 9: 02AM AL19SERJET FR}{ p• 1 <br /> DEPARTMENTENvmoNAUNTAL HEALTH <br /> SAN JOA UIN COUNTY <br /> Te! me:(209) 3U20 Fax:(209)46&3433 <br /> AUTHORIZATION TO RELEASE <br /> ANALYfICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIICONMSNTALISITE ASS ENT INFORItitATION <br /> 1,THE UNDERSIGNED OWNER AMIOR OPMATOR OF THE PROPERTY ANDIOR FACILITY <br /> LOCATED AT 7"$2 0 U f�✓ M tom" r WT#4 <br /> HERESY 3rP.P- LAS <br /> AUTHOUM <br /> t ) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN CO <br /> ENMONINENTAL HEALTH DEPARTMEINT AS SOON AS IT IS AVAILABLE AND AT THE S <br /> TDM 1T IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: l-cM 6.J' <br /> (7f Appbwble) <br /> OWNEMPERATOR: ()06 (i,bo <br /> Please Prt (7}rle) <br /> )k oc - )Ia►`l <br /> /owismr ) (Daft) <br /> ADDRESS: T604 060-c <br /> (Ua111ng Ad&ws) <br /> ml L.%.Ar— =` (a 6s <br /> (City) (Bute) (Zo code) <br /> PHONE: <br /> EH 23 046 8/x111) 8 <br />