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SANOAQUIN COUNTY PUBLIC HEALTH SERVCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (209)468-3420 <br /> AUTHORIZATION TO RELEASE <br /> • ANALYTICAL RESULTS <br /> • GEOTECIINICAL DATA <br /> • ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1. 7•HE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT Hutchins Street Square, 121 S. Hutchins Street, Lodi, CA 95240 <br /> Kraz@ffeft'A*Wlates (City) <br /> IIEREBY AUTHORIZE <br /> (Lahoratary) <br /> '10 RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> IIF.AL'I'If SERVICES-ENVIRONMENTAL IIEALTII DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: Hutchins Street Square <br /> (IJ Applicable) <br /> OWNER/OPERATOR: The City of Lodi/Public Works Dept. <br /> (Please <br /> ��Print) (7711e) / �7 <br /> (0w /Opera(or Signature) ' (Date) <br /> ADDRESS: P.O. Box 3006 <br /> (Mailing Address) <br /> Lodi, CA 95241-1910 <br /> (City) (State) (Lip Code) <br /> PIIONE: ( 209 ) 333-6800 ext. 593 <br /> FII 23 046 (Revised 9/11/96) Page 9 <br />