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,.. .. <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (709) 46&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 <br /> LOCATED AT 900'i E. Victor Road, Lodi , CA 95240 <br /> (Street Address) (City) <br /> HEREBY AUTHORIZE l li-)e GeoArlalytical Laboratories <br /> (Laboratory or nrullon!) <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 <br /> TO ME OR MY REPRESENTATIVE <br /> BUSINESS NAME: t/ <br /> (IjApplicabl <br /> OWNER/OPERATOR: <br /> (Please ' t (Tule) <br /> (Owner/O ra,A6r Signature) <br /> ADDRESS: <br /> 2 <br /> (Mailing Address) <br /> Cil �fS-2 l <br /> (City) (State) (Zip Code) <br /> PHONE: ( Z01 ) <br /> DATE: t /I LZ� <br /> EH 23 041 (Revised 7-10-92) Page 9 <br />