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PUBLIt HEALTH SERVICES <br /> SAN JOAQUIN CDUNr( :. L <br /> JOU KHANNA \LD.Sl.?K <br /> Hench Officer <br /> P.O. Box 2009 • (1601 East Hazelton Avenue) •Stockton. California 95201 <br /> (209) 468.3400 <br /> ENVIRONbIENTAL HEALTH DMSION <br /> (209) 468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECHNICAL DATA <br /> ' EWIRONMENTAUSUE ASSESSbIENT INFOPMATION <br /> I,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT 24 So. Hunter Street , Stockton , California <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE Kleinfelder <br /> (Laboratory or Consultant) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFOEMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TME IT IS PROVIDED <br /> TO ME OR ;vlY REPRESENTATIVE. <br /> BUSINESS NAME: <br /> (If Applicable) <br /> OWNER/OPERATOR: County of San Joaquin Purchasing Division <br /> (Please Print) (77tle) <br /> l (Signature) <br /> ADDRESS: 222 East Weber Avenue , Room 675 <br /> (Mailing Address) <br /> Stockton , California 95202 <br /> (City) (State) (zip code) <br /> PHONE: ( 209 468-3252 <br /> DATE: <br /> k 1`1 Igz <br /> EH 23 041 (REV 11/7/90) wP Page 9 <br /> A Dm,-n of San Jmgmn County H.Wth Gre Service �> <br />