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ENVIRONMENTAL HEALTH DEP VffffiED <br />SAN JOAQUIN COUNTY <br />k A. 0 6 2014 <br />'Telephone: (209) 468-3420 Fax: (209) 468-3433 <br />ENVIRONMENTAL <br />AUTHORIZATION TO RELEASE HEALTH DEPARTMENT <br />* ANALYTICAL RESULTS <br />* GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY LOCATED AT <br />1524 Fresno Ave <br />(Street Addre-ss) <br />Stockton <br />(City) <br />HEREBY AUTHORIZE <br />Kiff Analytical (La6o <br />ratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVA.II.,ABL.E AND AT THE SAME TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME: Valley Pacific Petroleum Services <br />__._.._._ (If Applicable) <br />OWNER: Mike Eliason Cardlock Manager <br />(Please Print) (rtle) <br />ADDRESS: 166 Frank West Circle <br />Stockton <br />PHONE: ( 209 993-8793 <br />EH 23 046 (Revised 07/21/10) <br />(Mailing Address) <br />(City) <br />0 <br />..I(/t % <br />(Date) <br />CA 95206 <br />(State) (Zip Code) <br />