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..00, <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 4032 N E1Dorado Street Stockton <br />(Street Address)c Campbell Analytical (City) <br />HEREBY AUTHORIZE MM <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 <br />(If Applicable) <br />OWNER/OPERATOR: Bob Eustis <br />Property <br />owner <br />(Ple��ase Print) <br />(7itle) <br />�' &4aL /) <br />6 <br />%_ Lab <br />(Owner/Operator Signature) <br />(Date) <br />ADDRESS: 5457 Covey <br />Creek Circel <br />(Mailing Address) <br />Stockton <br />CA <br />95207 <br />(City) <br />PHONE:( 209 ) <br />473-0501 <br />EH 23 046 (Revised 9/11/96) Page 9 <br />(State) (Zip Code) <br />