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� u <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONINIENTAL HEALTH DIVISION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> * ANALYTICAL RESULTS <br /> * GEOTECHNICAL DATA <br /> ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br /> I, THE UNDERSLGNEIZQWNER AND/OR OPERATOR OF ruF PROPERTY AND/OR FACILITY <br /> LOCATED AT 16500 E. Brandt Rd. , Lodi, CA 95240 <br /> (Streer Address)) City) <br /> HEREBY AUTHORIZE eoAnalytical Laboratories <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 SIE OR MY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If.-1pplicablej <br /> OWNER/OPERATOR: <br /> (Please Print) (Tule) <br /> ( - t-�2— <br /> (Owner perator Signature (Date) <br /> ADDRESS: P.O. Box 99320 <br /> 01failing Address) <br /> Stockton, CA 95209 <br /> (Cin•) <br /> Sratej Zip Code) <br /> PHONE: <br /> 209 9) 3-6110 <br /> ( <br /> EH 23 046 (Revised 08/13%99) Pa¢e 9 <br />