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%Vol <br /> 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 TJJHE PROPERTY AND/OR FACILITY <br /> LOCATED AT 3o/P, � Wa,k� bo -R 5fwx� O-P <br /> (Street A!vaxod—� <br /> (City)HEREBY AUTHORIZE <br /> (Laboratog or omultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED <br /> TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: UiC, �ky'r)anQ--Z- <br /> (Please Print) (Title) <br /> (Owner/Operator Signature) r� <br /> ADDRESS: 4J DS bm l dw <br /> (Ma d bngAddress) <br /> ,,,xt <br /> /(city) n (State) (Zip Code) <br /> PHONE:11 7/1-1,Kliv <br /> 7 2L <br /> r <br /> EH 23 041 (R ' 7-10-92) Page 9 <br />