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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 /> * ENVIRONMENTALISITE ASSESSMENT INFORMATION <br /> 1, THE UNDERSIGNED OWNER <br /> +AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT V I&' E I�OA�Q Lo t2 j <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE 5, U a t AA1,--f_'1�'�„A4, 9 - <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: P Dim MSN IGA�L ,.�iJG <br /> (If Applicable) <br /> OWNER/OPERATOR: <br /> (P ase Print) merle) <br /> ,r Z <br /> qwaer/Vpemor Signature) (Date) <br /> ADDRESS. VL100, WI,1,.L1 '�i �9r- <br /> (Mai ng Address) <br /> !ANN CA x%521-7 <br /> (City) (State) (Zip Cade) <br /> PHONE: ( t D ) Ci I A" $3G!0 <br /> EH 23 046 (Revised 10/19/98) Page 9 <br />