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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 /> ° FNVIRONWTFfAI_,/SYM ASSESSMENT INFORMAT'.T'DN <br /> I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 308 S . E1Dorado Street, Stockton, CA 95203 <br /> (Street Address) (C' <br /> HEREBY AUTHORIZE McCampbell Analytical, West Analytical, or Alpha Analytical <br /> (Laboratory or Consuit") <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: Den' s Auto <br /> (If Applicable) <br /> OWNER/OPERATOR: Mr. Den Ueda <br /> ((Please Print) (Title) <br /> (OwwoOpe� ignarure) <br /> ADDRESS: 308 S. E1Dorado Street <br /> (MmUng Address) <br /> Stockton, CA 95203 <br /> (City) (State) (Zip Code) <br /> PHONE: ( 209 462-1262 <br /> DATE: <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />