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SAN JOAQUIN COUNTY PUBLIC HEALTH SEk10CES <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 200 N. Beckman Rd. , Lodi CA 95240 <br /> (Street Address) (Ctn') <br /> HEREBY AUTHORIZE Ground Zero Anal sis/GeoAnal ti <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: San Joaquin County mosquito & Vector Control District <br /> (If Applicable) <br /> Same as above Owner <br /> OWNER/OPERATOR: (Tit e) <br /> leas Print) <br /> ( w er/Operator Signature) I (Date) <br /> ADDRESS: 7759 S. Airport Way, Stockton , CA 95206 <br /> (Mailing Address) <br /> Stockton, CA 95206 <br /> (City) State) (Zip Code) <br /> PHONE: ( 209 ) 952-4675 <br /> EH 23 046 (Revised 08/13/99) Page 9 <br />