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SAN 1' JUIN COUNTY PUBLIC HEALTH SERVF <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209) 468-]420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> • ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1, 111E UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED Ar 1645 Cherokee Rd. , Stockton, CA 95205 <br /> (Street Address) (Cloy) <br /> IIFRFBY AU111ORIZE GeoAnalytical <br /> /Jnbaramq) <br /> '10 RELEASE ANY AND ALL ANALYIICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIFALIH SERVICES-ENVIRONMEN"I'AL IIEALIII DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> IIMP I'1' IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> RUSINESS NAME: ' � ��i F.tNiis /2�cTio� Lo <br /> (IJ Applicable) <br /> OWNFR/OPERATOR: <br /> (Please Print) Mile) <br /> OUvner/Uperatar Signature (Dote) <br /> ADDRESS: QJ / e114l�.vGre S% / 1- <br /> (Afaiting Address) <br /> S-a�.�. <br /> (City) L' (State) (Lip Cade) <br /> PIIONE: (a(22) G <br /> Ell 23 046 (Revised 9/11/96) Page 9 <br />