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SAN #UIN COUNTY PUBLIC HEALTH SERV[ <br />ENVIRONMENTAL HEALTH DIVISION <br />(209) 468-3420 <br />AUT1I01UZATION TO RELEASE <br />* ANALYTICAL RESULTS <br />* GEOTECIINICAL DATA <br />ENVIRONMENTAL/SITE ASSESSMENT INFORMATION <br />1III- UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br />LOCATED AT 2201 W. Washington St., Stockton, CA 95203 <br />(Street address) (City) <br />IIFRF13Y AUIIIORIZ_E GeoAnalytical Laboratories <br />(I.ahn�ntnry) <br />'I0 HPI -PASS ANY AND ALI_ ANALYTICAL INFORMATION TO SAN 1OAQUIN COUNTY PUBLIC <br />IIF,AI-'I 11 SFIR VICES- ENVIRONMENTAL IIEALTII DIVISION AS SOON AS IT 15 AVAILABLE AND AT THE SAME <br />I IMI- FI IS PROVIDED TO ME OR MY REPRESENTATIVE. <br />11I SINESS NAME: The Port of Stockton <br />(If Applicable) <br />()WFlrR/UPFitA1OR: Same as above <br />(Blease Print) (Title) <br />AT <br />(Date) <br />ADDRESS: 2201 W. Washington St. / P.O. Box 2089 <br />(lifaiNng Address) <br />Stockton, CA 95201-2089 <br />(City) (State) (Zip Cade) <br />P110NE: ( 209 ) 946-0246 <br />11 23 046 (Revised 9111/96) Page 9 <br />