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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 /> ` ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND,'OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 7777 WEST ELEVENTH STREET TRACY, CALIFORNIA <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE MCCAMPBELL ANALYTICAL LABORATORY AND EPIGENE INTERNATIONAL <br /> (Laboratory or Consultant) <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: PTFDMONT I t IMRFR F M T I I cc)_., TN('_ <br /> (If Applicable) <br /> OWNER/OPERATOR: , x eA,5:e — <br /> (Please Pri (Title) <br /> ( er/Operator Signature) <br /> ADDRESS: 395 TAYLOR BOULEVARD, SUITE 225 <br /> (Mailing Address) <br /> PLEASANT HILL CALIFORNIA 94523 <br /> (City) (State) (Zip Code) <br /> PHONE: ( 510 674 8770 <br /> X DATE: <br /> EH 23 041 (Revised 7-10-92) Page TEN <br />