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M, <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 THE PROPERTY AND/OR FACILITY <br />LOCATED AT 103 North E Street Stockton <br />(Street Address) (City) <br />HEREBY AUTHORIZE Alpha Analytical <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: A. Teichert & Son <br />(/f Applicable) <br />OWNER/OPERATOR: George Takemori Project Manager <br />(Please Print) (Title) <br />10-3-00 <br />Signature) (Date) <br />ADDRESS: P.O. Box 15002 <br />(Mailing Address) <br />PHONE: <br />EH 23 046 (Revised 08/13/99) <br />Sacramento CA 95851 <br />(City) <br />916 )386-3716 <br />Page 9 <br />(State) (Zip Code) <br />