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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 />I, THE UNDERSIGNED OWNER AND/OR OPERATOR OF TIIE PROPERTY AND/OR FACILITY <br />LOCATED AT 1628 Harbor Ave Stockton <br />(Street Address) (City) <br />HEREBY AUTHORIZE Del—Tech <br />(Laboratory or n <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO <br />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: M C Liquors <br />(If Applicable) <br />OWNER/OPERATOR: <br />DATE: <br />ADDRESS: 1628 Harbor Ave <br />� i .uu,nx .yuaressl <br />Stockton CA 95203 <br />(City) (State) (Zip Code) <br />PHONE:( 09 ) 944-5523 <br />EH 23 041 (Revised 7.10-92) Page 9 <br />