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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUI COUNTY <br /> Telephone: (249)468-3420 Fax: (209)468-3433 <br /> AUTHORIZATION TO RELEASE <br /> * <br /> ANALYTICAL I1 ESULTS <br /> GEOTECHNICAL DATA <br /> ENVTRONMENTAUS1TE ASSESSMENT TWORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY ANWOR FACILITY <br /> LOCKMD AT Northeast: corner of Farmington Road and E Mariposa Rd Stockton, CA <br /> r(Slrct Address)........._.._�_.-.._.._.-_.................._._.........(Cfly)..,a _.�,...._._...----- <br /> HEREEY Sunstar Labs <br /> AUTHORIZE <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AVAILABLE AND AT THE SAME <br /> TIME ITIS PROVIDED TO ME OR MY REPRIFSENTATIVE. <br /> ffGSINi SS NANIIE; Walgreens <br /> .—(Ifripplicable) <br /> OWNEWPERATOR: Walter Hocutt - <br /> (P se Print) (Title) <br /> �"IrawnerlOperator Signature) (Dale) <br /> All1a1 SS��I E. 3rd Avenue <br /> San Mateo CA 94401 <br /> (00 0 ale) ("Lip Code) <br /> PHONE: 51a�434-9200 <br /> r L 1 N <br /> OCT 2 6 2011 <br /> SAN JOAQU.ev 000\0`( <br /> EH 23 046 (Revised 811 111) g EI mp,011MEiv i AL <br /> �., e q"p FR-Ik'? EN t <br /> -�-t�1.:1 R... ��f 4 <br />