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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209)468-3420 <br />AUTHORIZATION TO RELEASE <br />6MR,"Owa iCellIt3*1114M <br />. GEOTECHNICAL DATA <br />* ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATEDAT 310 N. Cluff Ave,Lodi, CA 95240 <br />(Street Address) (City) <br />HEREBY AUTHORIZE GeoAnalytical Laboratories <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: Ro-Tile <br />(If Applicable) <br />OWNERIOPERATOR: Lavor Thompson, Owner <br />(Plea"-Pn*0-_ (firle) <br />(Owner/Operator Signature) <br />ADDRESS: 310 N. Cluff Ave. <br />(Mailing Address) <br />_Lodi, CA 95240 <br />(City) (State) (Lip Code) <br />PHONE: ( 20q ) 26q-4751 <br />EH 23 046 (Revised 10/19/98) Page 9 <br />