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• • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 <br /> AUTHORIZATION TO RELEASE <br /> *ANALYTICAL RESULTS <br /> *GEOTECHNICAL DATA <br /> * ENVIRONMENTAUSITE ASSESSMENT INFORMATION <br /> 1,THE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILI <br /> LOCATED AT Northeast corner of Farmington Road and E Mariposa Rd St kion, CA <br /> (Street Address) (City) <br /> HEREBY Sunstar Labs <br /> AUTHORIZE <br /> (Laboratory) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION T SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT AS SOON AS IT IS AV ILABLE AND AT THE SAME <br /> TIME IT IS PROVIDED TO ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: PSI <br /> (If Applicable) <br /> OWNER/OPERATOR: Fr ss Department Manager S <br /> ase Print) (Title) _f <br /> (Owner/Operator Signat e) (D e) <br /> ADDRESS: 4703 Tidewater Avenu , Suite B <br /> (Mailing Address);' <br /> Oakland CA 94601 <br /> (City) (State) (Zip Code) <br /> PHONE: 510 434=9200 <br /> fr <br /> EH 23 046 (Revised 8/1/11) g <br />