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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <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 LOCATED AT <br />7 -Eleven #32190 - 4943 South State Route 99 Stockton - Ca 95206 <br />(Street Address) (City) <br />HEREBY AUTHORIZE <br />n/a <br />(Laboratory) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />DEPARTMENT AS SOON AS IT IS AVAILABLE AND A THE SAME TIME IT IS PROVIDED TO ME OR MY <br />REPRESENTATIVE. <br />BUSINESS NAME 7 -Eleven Inc <br />OWNER/OPERATOR: Randy Martin <br />(Please print) <br />(Owner/Operator Signature) <br />ADDRESS: P.O. Box 711 <br />PHONE: <br />EH 23 046 (revised 1/24/02) <br />c' ,Vf pkepeiai<h23046 w,d <br />(Mailing Address) <br />Dallas <br />(800)828-0711 <br />(City) <br />Page 5 <br />(If Applicable) <br />Environmental Manager <br />(Title) <br />(Date) <br />Texas 75204 <br />(State) (Zip Code) <br />Wo 4126686 <br />