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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUTHORIZATION TO RELEASE <br />a ANALYTICAL RESULTS <br />• GEOTECHNICAL DATA <br />• ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1, THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 900 1/2 E. Victor Road, Lodi, CA 95240 <br />(Street Address) (qty) <br />HEREBY AUTHORIZE GeoAnalytical Laboratories <br />(laboratory or Consultant) <br />TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br />HEALTH SERVICES AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS PROVIDED TO <br />ME OR MY REPRESENTATIVE. <br />BUSINESS NAME: TERESI TRUCKING INC <br />(If Applicable) <br />OWNER/OPERATOR : <br />ADDRESS: <br />(Mailing Address) <br />Lodi, CA 95241-1270 <br />(qty) (state) (WP) <br />PHONE: ( 209 368-2472 <br />DATE: // �ST <br />Page g <br />EH 23 041 (Redeed 7-1042) <br />